Orbital Floor Fractures-Reply

Abstract

In Reply. —Dr. Putterman objects to our suggestion that all fractures of the floor of the orbit with clinical symptoms and demonstrable x-ray evidence should be explored. He agrees with the need for early treatment of fractures of the zygomati-comaxillary complex, which involves the orbital floor (impure blow-out) but insists that these should be separated from fractures of the floor alone (pure blow-out). In fact, we carefully separated these two major classifications and suggested the use of coexisting and isolated groupings to emphasize this separation. Limiting the discussion to the isolated, pure blow-out fracture, Putterman and his associates reject the entrapment of the inferior rectus muscle or penetration of the orbital fat through the damaged floor, or both as a cause of diplopia and enophthalmos. This pathogenesis has been documented in the experimental laboratory and repeatedly at surgery by direct observations and forced traction tests since the early reports of