The Journal of Craniofacial Surgery
Analysis of Orbital Bone Fractures: A 12-Year Study of 391 Patients
Kun Hwang, MD, PhD,* Sun Hye You, MD,† and In Ah Sohn, RN, PhD‡
(J Craniofac Surg 2009;20: 1218–1223)
From the *Department of Plastic Surgery and Center for Advanced Medical Education by BK21 Project, Inha University College of Medicine; †Department of Plastic Surgery, Inha University Hospital; and ‡Department of Emergency Medical Technology, Gachon University of Medicine and Science, Incheon, Korea. · Received November 5, 2008. · Accepted for publication April 10, 2009. · Address correspondence and reprint requests to In Ah Sohn, RN, PhD, Department of Emergency Medical Technology, Gachon University of Medicine and Science, 534-2 Yeonsu-dong, Yeonsu-gu, Incheon, 406-799, Korea; E-mail: jokerhg@naver.com · This study was supported by the Korea Research Foundation Grant, funded by the Korean government (KRF-2008-521-E00002). · Copyright © 2009 by Mutaz B. Habal, MD · ISSN: 1049-2275 · DOI: 10.1097/SCS.0b013e3181acde01 · 1218 The Journal of Craniofacial Surgery • Volume 20, Number 4, July 2009
Abstract
This retrospective study evaluates 391 patients with orbital bone fractures from a variety of accidents that were treated at the department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, South Korea, between February 1996 and April 2008. The medical records of these patients were reviewed and analyzed to determine the clinical characteristics and treatment of the orbital bone fractures.
The following results were obtained. The mean age of the patients was 31.1 years, and the age range was 4 to 78 years. The most common age group was the third decade of life (32.5%). There was a significant male predominance in all age groups, with a ratio of 4.43:1. The most common etiology was violent (assault) or nonviolent traumatic injury (57.5%) followed by traffic accidents (15.6%) and sports injuries (10.7%).
The most common isolated orbital bone fracture site was the orbital floor (26.9%). The largest group of complex fractures included the inferior region of the orbital floor and zygomaticomaxilla (18.9%). Open reduction was performed in 63.2% of the cases, and the most common fracture reconstruction material was MEDPOR (56.4%) followed by a resorbable sheet (41.1%). The postoperative complication rate was 17.9%, and there were no statistically significant differences among the reconstruction materials with regard to complications. During follow-up, diplopia, hypoesthesia, and enophthalmos occurred as complications; however, there was no significant difference between porous polyethylene sheet (MEDPOR) and resorbable sheet groups.
Long-term epidemiological data regarding the natural history of orbital bone fractures are important for the evaluation of existing preventative measures and for the development of new methods of injury prevention and treatment.
Key Words
Orbital fractures, diplopia, hypoesthesia, enophthalmos
Fractures of the orbital wall are common injuries.¹ During their natural course, herniated orbital tissue can be trapped in a fractured opening or herniated through the maxillary or ethmoidal sinus, causing diplopia and enophthalmos, resulting in disfigurement.² Failure of prompt recognition and treatment of these injuries may result in significant morbidity.³ A comprehensive knowledge of the characteristics of this patient population is valuable for their management. Unfortunately, much of the current literature on orbital floor fractures is either out of date or based on small groups of patients.³
In attempt to assess the extent and etiology of orbital bone fractures, we gathered information on a large number of clinically relevant variables and performed statistical analyses to provide clinically useful data. We investigated and analyzed the incidence, type, etiology, injury pattern of hard tissue, and associated injuries, as well as the treatment and outcome of orbital bone fractures.
An understanding of the cause, severity, and temporal distribution of facial trauma might aid in establishing clinical and research priorities for effective treatment and prevention of these injuries.⁴ The epidemiological trends with regard to specific injuries are always changing and are reflections of the demographic and social behaviors and the time the population was studied. This constant flux makes periodic review a useful and valuable exercise to monitor the changing trends.⁵
The purpose of this study was to evaluate the natural history of orbital bone fractures in 391 cases over 12 years at the Department of Plastic Surgery, Inha University Hospital, Incheon metropolitan city, South Korea.
PATIENTS AND METHODS
The medical records of patients seeking treatment for orbital bone fractures were reviewed at the Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon metropolitan city, South Korea. The study population consisted of 391 severely injured patients with orbital bone fractures from February 1996 to June 2008. The parameters assessed were age, sex, time of injury, etiology, injury types, and associated injuries, in addition to the type of fracture and treatment modality. The orbital bone fractures were classified as isolated or complex fractures for most patients. The isolated orbital bone fractures included orbital floor, medial, roof, and lateral bone fractures. The complex fractures were subclassified into 5 types according to the anatomic direction from the orbit and the extension from an adjacent area, which were inferior, medial, superior, lateral, or other locations (Table 1). In addition, the complications and follow-up were analyzed to investigate the data on the postoperative outcome with 2 synthetic orbital implants: porous polyethylene (MEDPOR; Porex Surgical Inc, Newman, GA) and the resorbable sheet (Inion CPS; Inion Oy, …