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Elana S. Rosenberg, Julia Nemiroff, Samuel Baharestani; Orbital Fractures in the Elderly: 35 consecutive cases presenting to a New York City Level I Trauma Center over a 52 month period. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4961.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate demographic characteristics and ocular findings of elderly patients presenting with orbital fractures.
This retrospective chart review identified all patients presenting to the Bellevue Hospital Emergency Department with orbital fractures from July 1, 2007 through October 31, 2011. The elderly cohort (65 and older) was studied in greater detail by chart and radiological review with attention to variables such as mechanism of injury, fracture characteristics and associated complications. An IRB exception was obtained from the Bellevue Hospital Research Committee.
Over this 52 month period, 391 fractures were recorded, peaking among patients in their 20s (29.7%) and 40s (21.2%). Fractures among the elderly comprised 8.9% (35/391) of the total. In the elderly cohort, 40% (14/35) of patients were female, while in the under 65 population, only 15.4% of patients were female. In the elderly cohort, falls were the most common etiology of fracture in both genders, effecting 86% of women (12/14) and 52% of men (11/21). The remaining 14% of women (2/14) reported a motor vehicle accident as did 14% of men (3/21). An additional 19% of men (4/21) reported assault and 14% (3/21) reported being struck as a pedestrian by a vehicle. There were virtually equal numbers of simple (one orbital wall) and complex (multiple wall) fractures. Neither age nor gender was correlated with fracture complexity (correlation coefficients of -0.07 and 0.01). All reported assaults and motor vehicle accidents resulted in simple fractures, while 61% of falls (14/23) and all pedestrian accidents resulted in complex fractures. Ocular complications from fractures were relatively uncommon but did include 4 cases of retrobulbar hemorrhage, 1 case of commotio retinae, and 1 entrapment. There were no reports of retinal detachment.
Orbital fractures are more evenly divided between men and women among the elderly than in the younger population. Falls, well known to be a major source of elderly morbidity, caused most of the fractures in the elderly cohort and were more likely to cause complex rather than simple fractures. Clinicians should have a high index of suspicion for complex orbital fractures in any patient who sustains a fall with periorbital trauma.
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