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S. Baharestani, C. Rosenberg, J. Nemiroff, B. J. Lissauer; Factors Associated With Acute Orbital Fractures: A Review of 153 Consecutive Cases. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4876.
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To investigate epidemiologic factors, co-morbidities, and the interdisciplinary approach to the evaluation and management of acute orbital fractures (AOF) that present to a Level I trauma center of a New York City public hospital
We conducted a retrospective review of 153 cases of acute fractures of the orbital wall(s) that presented to Bellevue Hospital from July 2007 to June 2009. Medical records were screened for demographic features, associated history, ocular/systemic co-morbidities, and radiographic findings. An IRB exemption was obtained from the Bellevue Research Committee.
Mean age in the study cohort was 39.8 years (Range: 1 - 96 years) with 5.8% pediatric patients and 83.9% males. Thirty-four percent of cases were seen in the summer months with 72.9% from blunt trauma, 15.5% from falls, and 11.6% from motor vehicle accidents. Via radiographic review, fractures of only the orbital floor comprised 34.2% of cases, only the medial wall was 12.9%, while 6.5% of cases involved either only the orbital roof or lateral wall, respectively. Forty percent of cases involved multiple walls. To review the need for emergent repair, one case (0.65%) of hemodynamic instability from the oculocardiac reflex (OCR) was noted while 41.6% of cases demonstrated restriction of extraocular muscles (EOM). However, only 15.1% (n=21 of 137) of communicative patients voiced subjective diplopia and only 9.3% of total cases showed radiographic evidence of muscle entrapment. Because of inter-observer variability in data tabulation, cosmetically-unacceptable enophthalmos and fracture size were not recorded although represent well-described reasons for emergent repair. Retrobulbar hemorrhages requiring prompt canthotomy/cantholysis were present in 9.3% of patients and only 1 case of retinal detachment was noted.
Adult males with fractures of multiple orbital bones via blunt trauma represent the overwhelming majority of cases of AOF. Our patients more often exhibit restriction of EOMs than radiographic evidence shows muscle entrapment, with diplopia only occassionally being present. Although rare, the OCR remains a bona fide basis for emergent repair. Whereas these cases are important to evaluate urgently, our experience indicates that cases requiring emergent repair are uncommon.
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