Medial wall fracture: an update

Abstract

This article is a review of the literature and update for management of medial orbital wall fractures. A retrospective review of the literature was performed via PubMed to review the diagnosis and management of medial wall orbital fractures. Medial wall orbital fractures though commonly accompanying orbital floor fractures can also occur alone. There are two primary theories explaining the pathophysiology of medial wall fractures: the hydraulic theory and buckling theory. Most fractures do not require treatment. "White-eyed" trapdoor fractures necessitate immediate surgery to reduce the risk of muscle fibrosis. Trapdoor fractures are more common in the pediatric population. The vast majority of nondisplaced fractures without entrapment do not require surgery. Evaluating patients with medial wall fractures requires evaluation of muscle motility and relative enophthalmos. Patients with entrapped muscles require immediate treatment to prevent permanent injury to the muscle.

Keywords: Orbital fracture; diplopia; enophthalmos; extraocular muscle entrapment; medial wall; surgical repair.

Figure 1

Computed tomographic scan of a patient who had undergone left orbital floor repair with a previously undiagnosed left medial wall fracture. Note distance from nasal septum to medial orbital wall is much reduced compared with the right side.

Figure 2

Diagram showing (A) anterior entrapment of the taut medial rectus muscle resulting in (B) limited abduction. (C) Entrapment with slack of the medial rectus muscle will allow abduction but less effective adduction. (D) No limitation of abduction.

Figure 3

Patient with right-sided enophthalmos, most easily seen with patient leaning his head back.