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Kathleen Oktavec, Shannath Merbs, Michael Grant; Clinical outcomes of surgically-treated trapdoor fractures in the pediatric population. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4433.
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A trap-door orbital floor fracture, in which an extraocular muscle is incarcerated in a small defect in the orbital floor, is an often cited indication for acute repair. Previous studies have indicated that rapid identification and early repair of this type of fracture is associated with a better outcome. In order to learn more about the prevalence and outcomes associated with inferior rectus entrapment, we have reviewed our experience with pediatric trapdoor fractures.
Retrospective chart review of 205 pediatric patients with an orbital fracture surgically treated in the Division of Oculoplastics, Wilmer Eye Institute from January 1991 through December 2011. Forty-eight of the 205 patients treated during this period were found to have trapdoor floor fracture with incarceration of the inferior rectus muscle utilizing the following inclusion criteria: 1) Attending note stating the patient had a history and exam consistent with a trapdoor fracture 2) a CT scan demonstrating a trapdoor fracture 3) an operative note stating forced ductions were positive and the muscle was seen to be incarcerated. Clinical outcomes were compared between groups using contingency tables and Fisher’s exact tests.
The median age at time of injury was 13.7 years. 79% of patients were male; 58% were Caucasian. The most common mechanism of injury was sports-related (42%), and 10 patients had associated anterior (microhyphema) and/or posterior (commotio retinae) ocular injuries. The median duration of injury to surgical repair was less than one day (0 to 27 days). The most common presenting symptom was double vision (87%), followed by pain with attempted eye movement (71%) and nausea/vomiting (69%). Over a median follow up of 4 months (0.8 to 139.6), no patient needed additional surgical treatment. 7 of the 48 patients had residual strabismus at last follow up, all of whom had surgery > 4 days following injury.
Our data suggest that early surgical intervention of pediatric trapdoor floor fractures leads to a better clinical outcome, and that injury to the muscle continues until the inferior rectus muscle is released.
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