INTRODUCTION: Frontal fractures result from high force injuries and have significant morbidity and mortality. By gaining a thorough understanding of the mechanism, associated injuries and related complications of this diagnosis, clinicians will be better able to provide optimal treatment of these patients and ultimately improve outcome. The purpose of this study was to evaluate our McGill University Health Centre (MUHC) experience with frontal bone fractures and associated injuries. METHODS: A comprehensive review of the MUHC database was performed. All adult patients presenting with frontal sinus fracture were identified. Patient demographics, mechanism of trauma, fracture type, associated facial injuries, management and related complications were identified. All cases of ocular injury or sequalae were identified and an in-depth review was performed. RESULTS: Between 2008 and 2014, 1277 patients presented to the MUHC Level 1 trauma center with a facial fracture, 140 of whom had a frontal sinus fracture and met the inclusion criteria. Mean age was 43.5 years, 90% were male and mean hospitalization time was 16.2 days, including those who required prolonged ICU admissions. Among the patients treated surgically, only 2 required re-operation for their facial fractures (1.4%). A significant proportion suffered concomitant craniomaxillofacial fractures including orbital (79%), maxillary (66%), nasal (64%), zygomaticomaxillary complex (34%), nasoorbitoethmoid (31%), Lefort types I-III (18%) and mandibular (8%). Associated cervical spine injuries were seen in 16% of patients. Ocular injuries were present in 29% of subjects. The most frequently ocular pathologies were optic neuropathy, ptosis and orbital hematoma, followed by subconjunctival hemorrhage, mydriasis, exotropia, retinal injury, gaze limitation and rectus entrapment. Fifty percent were extraocular in nature, 30% were due to mechanical force, and 6% involved palsy of cranial nerves. CONCLUSION: Due to the intimate association of the frontal bones with the brain and the orbits, frontal sinus fractures rarely occur in isolation and demand a sophisticated multidisciplinary approach. Given this high rate of ocular injury, the authors propose a modified treatment approach and algorithm. In order to optimize the treatment of systemic injuries and preserve eyesight, fracture repair may need to be postponed and performed in a delayed fashion.