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Emily M. Bratton, Emily McCourt, Vikram Durairaj; Occurrence of Facial Fractures in Children Presenting with Hyphema. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1022.
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To describe facial fractures associated with traumatic hyphema in children, identify the mechanisms of injury, and indications for imaging.
This is a retrospective chart review of all patients seen in the emergency department at Children’s Hospital Colorado between July 1, 2009 and June 30, 2011 diagnosed with hyphema. Concomitant occurrence of facial fractures was reviewed.
Traumatic hyphema occurred in fourty-nine patients. Fifteen children underwent computed tomography (CT) imaging at presentation. Seven children (14.3%) had associated facial fractures. The majority of patients were male (85.7%), with a mean age of 13 years. The most common facial fractures involved the floor (4) and medial wall (5) of the orbit. While most children with hyphema complained of eye pain, patients with orbital fractures were more likely to complain of periorbital pain or pain with eye movement. No patients had clinical or radiologic evidence of muscle entrapment or required surgery. Six patients (85.7%) with fractures had extensive periorbital ecchymosis and eyelid swelling on examination. Two patients had associated lid lacerations. Half of the cases of orbital fractures were associated with baseball injuries (3). Other injuries resulting in fractures occurred with a lacrosse ball, golf club, bungee cord and assault. Patients with injuries from small or soft objects had mild lid swelling with minimal erythema or ecchymosis. Of the patients imaged with these injuries, no facial fractures were observed.
This study highlights the importance of determining the mechanism of injury in patients presenting with traumatic hyphema in order to assess risk of facial fractures. Detailed physical examination aids in the decision to perform CT imaging. Extensive periorbital ecchymosis, eyelid swelling, periorbital pain and restriction of motility should raise suspicion for associated fractures. Particularly when the injury occurs with a mid-sized, firm object. Patients with injuries sustained from small, soft objects without these clinical signs are less likely to have fractures. This study is the first to describe facial fractures in patients presenting primarily for traumatic hyphema.
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