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MP Grant, SL Merbs, PN Manson, NT Iliff; Outcomes following Repair of Pediatric Trapdoor Fractures . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3042.
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Purpose: A trapdoor-type fracture, in which an extraocular muscle in incarcerated in a small orbital fracture, is often cited an indication for acute repair. Previous studies have suggested that early repair of this type of fracture, with release of the entrapped muscle, is associated with a better outcome. However, more recently, studies have suggested that early intervention may not be as critical as once suspected. To learn more about outcome as a function of timing of repair of trapdoor fractures in children, we reviewed our experience with pediatric trapdoor fractures. Methods: A retrospective chart review of all pediatric (6-17 yo) orbital fractures treated at our institution from 1991-2001 was performed with IRB approval. Twenty-five of the 62 patients treated met the following inclusion criteria: 1) Attending note stating the patient had a history and exam consistent with a trapdoor fracture and extraocular muscle incarceration, and 2) a CT scan demonstrating a trapdoor fracture, and 3) an operative note stating that forced ductions were positive and there was incarceration of the muscle. Results: Of the 25 patients identified, 21 were male, with a mean age of 9 years. Twenty of 25 fractures were the result of athletic injuries or accidental contact. The large majority were orbital floor fractures with incarceration of the inferior rectus; however, two were medial wall fractures with incarceration of the medial rectus. The most common presenting symptom was double vision (92%), followed buy nausea/vomiting (63%), and pain with eye movement (50%). No patient had evidence of associated anterior or posterior segment trauma. At our institution, trapdoor fractures are typically repaired within 24 hours of presentation. Due to delay in presentation or referral, a range of intervals between injury and repair were observed. Eleven of 25 patients were repaired within four days of injury, and none had residual strabismus. Five patients were repaired within 5-8 days, and 2/5 had residual strabismus. Four patients were repaired 9 or more days after injury, and 2/4 had residual strabismus. Conclusion: Our study demonstrates a trend toward a better post-operative outcome with early surgical repair of the trapdoor fracture and release of the incarcerated muscle in the pediatric population.
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