Clinical analysis after treatment of 23 orbital Trapdoor fracture cases

Abstract

Objective To analyse treatment modalities for Orbital Trapdoor Fractures based on clinical data. Methods Clinical data of orbital trapdoor fractures diagnosed at the Second Hospital of Dalian Medical University between November 2012 and July 2014 were retrospectively analysed. 23 cases of orbital trapdoor fracture were included. All fractures were approached transconjunctivally. For 16 cases, absorbable material was chosen to reduce and rigidly fix the fractures while for 7 cases, the bone and soft tissue were just reduced to anatomical positions. Efficacy of either treatment modality was assessed by reviewing CT scans as well as clinical manifestations of diplopia, enophthalmos, eyeball motility with a 6 months follow-up. Results 23 cases of patients before and after surgery no statistic difference in visual acuity. Pre-operatively, 21 patients had diplopia, 20 had motility limitation while 2 had enophthalmos. Post-operatively, all cases of enophthalmos were repaired. Only 2 patients has residual diplopia and limitation of eyeball motility for up gaze. Post-operative CT scans show proper orbital reconstruction with anatomic reduction of herniated orbital soft-tissue and fracture fixation. Conclusion Orbital trapdoor fracture is a special type of small bone defect、line-shaped、green-stick fracture. The patients can have the special manifestation of motility limitation. For the cases which the forcedduction test is ineffective, always need emergent surgery within 48 hours. Transconjunctival approach is the proper choice, during reduction and fixation of the fracture, we can use absorbtable material or just put the bone and soft tissue on the anatomic position. Key words: orbital trapdoor fracture; orbital reconstruction; transconjunctival approach; absorbable orbital implants.