Orbital blow-out fractures in children: Characterization and surgical outcome

Background: Trapdoor-type orbital fractures usually associated with marked motility restriction are common in the pediatric age group. We reviewed the characterization and surgical outcomes of orbital blow-out fracture in children. Method: This is a retrospective review study. From Jan. 1997 to Dec. 2006, 75 patients under 18 years of age with orbital blow-out fractures were seen in the department of ophthalmology, Chang Gung Memorial Hospital. The medical records and computed tomography scans of these patients were reviewed. Results: Forty-one patients were identified whose records were adequate to compare data. The mean age of the patients was 12.7 years and the mean duration of follow-up was 6.5 months. The most common causes of injury were assault (43.9%) and motor vehicle accidents (29.3%). Ninety-five percent of the patients had diplopia and ninety-three percent had extraocular muscle limitation. The incidence of trapdoor fracture in pediatric orbital fracture was 68.3%. Orbital blow-out fractures in these children most frequently involved the isolated orbital floor. The average time to surgical intervention was 23 days after injury; 53.8% patients received immediate (0-2 days) or early (3- 14 days) repair. Improvement from preoperative supraduction limitation was statistically significant in the immediate (0-2 days), early (3-14 days) and delayed (15-30 days) surgical groups. Conclusion: Orbital blow-out fractures in our pediatric patients were usually the result of assault or motor vehicle accident. Surgical repair within one month of injury led to better improvement and more complete resolution of ocular motility limitation and diplopia than late repairs.