Orbital fractures in children: a review of outcomes

Abstract

The third most common facial fractures in children are fractures of the orbit, and the medial wall and floor are the commonest sites affected. The aetiology, clinical presentation, and timing of operation all differ from those of adults. If there are few or no clinical signs, but oculocardiac reflex is present, it is highly suggestive of trapdoor injury. This retrospective study includes all consecutive children (younger than 18 years) referred with confirmed fractures of the orbital floor over a 5-year period (2005-2010). A total of 24 patients were identified with a mean age of 13.5 years, and most injuries were secondary to falls. Isolated injury to the orbital floor occurred in 14 (58%); the rest involved other fractures of the orbital wall or face, or both. There were 11 trapdoor fractures (46%), and 9 open blow-out fractures (38%). Overall, nausea and vomiting occurred in 13 patients (54%); 8 of these had trapdoor fractures. Most patients had operations (22, 92%), and the mean time to operation was 4 days. Complications increased with delays to theatre. Those operated on within 1 day had fewer complications than those who had operations after 3 days. Postoperatively, diplopia (n=6/11) and restricted eye movement (n=3/11) were associated with trapdoor injury, while enophthalmos (n=1/9) and paraesthesia (n=3/9) were related to open blow-out fractures. To reduce compromised outcomes, prompt operation is warranted in all children with fractures of the orbital floor regardless of the configuration.

Keywords: Fracture; Orbital; Outcomes; Paediatric.