Abstract
This study is aimed to determine the appropriate timing of performing surgical reduction on trapdoor fractures for bringing out better visual outcomes and the factors influencing surgical outcomes in this special subgroup of fracture victims. Data for 72 patients of orbital trapdoor fracture were analyzed retrospectively. Post-operative diplopia is the main posttreatment outcome of orbital bone fracture reduction. The receiver-operating characteristic (ROC) analysis indicated the cut-off point of surgical reduction timing at day 10 post-fracture. The rate of postoperative diplopia showed a significant difference between patients who underwent surgical reduction within 10 days and those who did after 10 days of injury (5.3% vs. 38.2%). Multivariate analysis revealed that preoperative infra-duction limitation (p = 0.02), muscle incarceration (p = 0.01), duration from injury to surgical reduction (p = 0.004), and postoperative supra-duction limitation (p = 0.004) were independent factors for poor surgical outcomes. In younger patients with head injury, the diagnosis of orbital trapdoor fracture should be kept in mind. Timely recognition and surgical reduction, especially within 10 days, can result in better visual outcomes without the occurrence of postoperative diplopia.
Highlights
This study is aimed to determine the appropriate timing of performing surgical reduction on trapdoor fractures for bringing out better visual outcomes and the factors influencing surgical outcomes in this special subgroup of fracture victims
The inclusion criteria were as follows: (1) patients who received a diagnosis of orbital trapdoor fracture at presentation or after image study, (2) those who presented to our emergency room or outpatient clinic seeking primary reduction, (3) those who were under the age of 25 years and had no history of diplopia or previous ocular trauma; and (4) those who were followed up for at least 3 months post-surgery
Assault was the most common cause of orbital trapdoor fractures in children and young adults, in age groups ranging from 6 to 25 years. This was compatible with the survey conducted by Yoon et al in Korea, where assault accounted for 68.2% in 44 children[12]
Summary
This study is aimed to determine the appropriate timing of performing surgical reduction on trapdoor fractures for bringing out better visual outcomes and the factors influencing surgical outcomes in this special subgroup of fracture victims. The rate of postoperative diplopia showed a significant difference between patients who underwent surgical reduction within 10 days and those who did after 10 days of injury (5.3% vs 38.2%). Recognition and surgical reduction, especially within 10 days, can result in better visual outcomes without the occurrence of postoperative diplopia. Orbital trapdoor fracture is an anatomic subtype of orbital floor fracture, and is a commonly seen orbital floor fracture in children. It was first described by Soll and P oley[2]. Delayed surgical repairs of trapdoor fractures may occur when the children present with white eyes or when their symptoms, such as nausea and vomiting following traumatic injuries, are misdiagnosed and managed as post-contusion syndrome
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