Lateral Wall Fracture Research Articles

Patterns and injuries associated with orbital wall fractures in elderly patients who visited the emergency room: a retrospective case-control study.

ObjectivesThis study aimed to determine orbital wall fracture (OWF) patterns and associated facial injuries in elderly patients and compare them with those in their younger adult counterparts.DesignA retrospective case–control study.SettingAn emergency department of a university-affiliated hospital located in an urban area.ParticipantsA total of 1378 adult patients with OWF diagnosed by CT from 1 January 2004 through 31 March 2014 were enrolled. Patients were categorised into elderly (≥65 years) and non-elderly (<65 years) groups.ResultsThe elderly group (n=146) had a mean age of 74.0 years compared with 37.5 years in the non-elderly group (n=1232). Slipping was the most common cause of OWF in the elderly group (43.8%, p<0.001), whereas violence was the most common cause in the non-elderly group (37.3%, p<0.001). The lateral orbital wall was the more common site of fracture in the elderly group, and their injuries were more often associated with concurrent facial bone fractures, including the mandible, maxilla and zygoma, compared with the non-elderly group. After adjusting for sex and the mechanism of injury, inclusion in the elderly group was a significant risk factor for fracture of the lateral wall (OR 1.658; 95% CI 1.074 to 2.560) and concomitant facial bone fractures of the maxilla (OR 1.625; 95% CI 1.111 to 2.377) and zygoma (OR 1.670; 95% CI 1.126 to 2.475).ConclusionsElderly patients were vulnerable to facial trauma, and concurrent facial bone fracture associated with OWF was more commonly observed in this age group. Therefore, a high index of suspicion and thorough investigation, including CT, for OWF-associated facial bone fractures are important.

Clinical observation on the improved reductive surgery for the treatment of zygomatic complex fractures

Objective To observe the clinical effect of improved reductive surgery for zygomatic complex fracture. Methods Thirty-two patients with zygomatic complex fractures were given zygomatic arch and lateral orbital wall fracture CT 3D reconstruction before operation to display position of fracture. The skin incision was made along the lower eyelid margin and extended about 15 mm outward canthus. Then the periosteotomy was done and the periosteum was separated to the back of zygomatic arch. The fracture was fixed with micro titanium nail plate to restore the normal anatomical position of zygomatic arch and to reset orbital margin completely. Results Two weeks after the operation, the soft tissue swelling of the orbital region faded. The deformity was completely corrected, and the opening movement of mouth was improved obviously compared with that before the operation. Three months after the surgery, the zygomatic appearance was symmetrical in 32 cases, with no obvious differences in appearance. Mouth opening degree was higher than 40 mm.The two eyeballs were symmetrical. Conclusion The improved subciliary approach combined with micro titanium nail and plate for zygomatic complex fracture has good effect. Key words: Fractures, traumatic; Zygomatic complex; Reductive surgery, modified; Incision

Comparison of proximal femoral nail antirotation and proximal femoral nail antirotation-II in treatment of femur intertrochanteric fracture

Objective To compare the clinical effects of proximal femoral nail antirotation (PFNA) and proximal femoral nail antirotation-Ⅱ (PFNA-Ⅱ) in the internal fixation of femoral intertrochanteric fracture. Methods A retrospective study was conducted of the 54 patients with femoral intertrochanteric fracture who had been treated at our department from May 2009 through July 2014. During May 2009 and November 2011, 27 of them were treated with PFNA; during December 2011 and July 2014, the other 27 of them were treated with PFNA -Ⅱ. The 2 groups were compared in terms of operation time, intraoperative blood loss volume, hidden blood loss volume, intraoperative and postoperative complications, fracture healing time and Harris hip score at the last follow-up. Results In the PFNA group, 27 patients were followed up for an average time of 22.6±4.8 months. In the PFNA-Ⅱ group, 27 patients were followed up for an average time of 19.5±4.6 months. The PFNA group had significantly more intraoperative blood loss volume (130.1±74.3 mL), and significantly higher rates of intraoperative lateral wall fracture of the proximal femur (18.5%, 5/27), postoperative lateral thigh soft tissue irritation (22.2%, 6/27) and postoperative thigh pain (22.2%, 6/27) than the PFNA-Ⅱ group [46.3±23.1 mL, 0, 3.7% (1/27), 3.7% (1/27), respectively] (P 0.05). Conclusion Compared with PFNA, PFNA-Ⅱ may lead to a smaller volume of intraoperative blood loss and a lower incidence of complications related to internal fixation. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails

Diagnostic performance of isolated orbital CT scan for assessment of globe rupture in acute blunt facial trauma

ObjectivesWe determine the diagnostic performance of emergent orbital computed tomography (CT) scans for assessing globe rupture in patients with blunt facial trauma. MethodsWe performed a retrospective cohort study based on prospectively collected trauma registry and acute care surveillance data in a tertiary-care hospital. Patients aged at least 18 years who underwent isolated orbital CT scanning for assessing potential ocular trauma were examined. Analyses were performed to evaluate the magnitude of agreement between diagnosis by CT scanning and ophthalmic assessment, including globe rupture. ResultsOur study cohort comprised 136 patients, 30% of whom (41 patients) sustained orbital wall fractures. Concordance for orbital CT diagnosis and the ophthalmic assessment of globe rupture was substantial (k=0.708). The relative risk of globe rupture was 0.692 (95% confidence interval (CI): 0.054–8.849) for superior wall fractures, 0.459 (95% CI: 0.152–1.389) for inferior wall fractures, 2.286 (95% CI: 1.062–4.919) for lateral wall fractures, and 0.637 (95% CI: 0.215–1.886) for medial wall fractures. According to multivariate analysis, lateral wall fractures were an independent risk factor for globe ruptures (adjusted odds ratio (OR)=12.01, P=0.011), and medial or inferior wall fracture was a protective factor (adjusted OR=0.14, P=0.012). In the stratified analysis of diagnostic performance of CT scan, specificity was highest among patients with orbital wall fractures (97.2%), followed by negative predictive volume (NPV, 97%), and accuracy (95.1%). ConclusionAmong patients with blunt facial trauma who underwent isolated orbital CT scanning as part of ocular trauma assessment, the diagnostic performance of CT in detecting globe rupture is more accurate in patients with orbital wall fractures. Nevertheless, isolated orbital CT alone does not have a sufficiently high diagnostic performance to be reliable to rule out all globe ruptures. Lateral orbital wall fractures in blunt facial trauma patients, in particular, should prompt thorough evaluation by an ophthalmologist.

Acceso retrocaruncular para la reconstrucción de la pared medial de la órbita

ObjectiveTo present a retrospective analysis of the use of retrocaruncular approach to access medial orbital wall reconstruction. Additionally, the technique for performing this access is described. Material and methodThe sample for this study was chosen from the population of patients referred to the Maxillofacial Surgery Service at the Hospital Clínico Mutual de Seguridad C.Ch.C (Santiago, Chile) for the treatment of orbital fractures between 1st of January 2011 and 31st of December 2014. Subjects eligible for study inclusion had age ≥18, either isolated medial orbital wall fractures or combined with floor fractures, uni or bilateral, with surgical indication, accessed with retrocaruncular approach and 6 month of follow up at least. Exclusion criteria: roof and/or lateral orbital wall fractures. ResultsBetween January 2011 and December 2014, a total of 168 orbits were treat. 27 orbits with medial wall fractures were accessed with retrocaruncular approach with transconjunctival extension and lateral canthotomy and were included in this study. Of them, 6 were pure medial wall fractures and 21 combined with floor fractures. Except for one case that required delayed reconstruction with customized orbital implant, all orbital reconstructions were successful in the first surgery. Except for a patient who developed a conjunctival granuloma in relation to the caruncle, no patients had complications related to retrocaruncular access. ConclusionesThe retrocaruncular approach presented allows asafe, wide and direct access for repairing medial orbital wall fractures with optimal aesthetics results and minimal functional complications.

A Comparison of Internal Fixation and Bipolar Hemiarthroplasty for the Treatment of Reverse Oblique Intertrochanteric Femoral Fractures in Elderly Patients.

PurposeTo compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients.Materials and MethodsFrom January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases).ResultsEarly ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation.ConclusionIn the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.

Commentary: Morphology and fixation pitfalls of a highly unstable intertrochanteric fracture variant.

fractures with an intact posteromedial buttress, have been successfully treated with a sliding hip screw or blade.1 However, unstable intertrochanteric fractures tend to collapse even after adequate reduction and fixation with plating, and thus intramedullary nailing is recommended.2 Unstable intertrochanteric fractures include fractures with posteromedial comminution, a reverse oblique configuration, subtrochanteric extension, lateral wall fractures, or a split in the coronal plane. The ‘lateral wall’ is important in the stability of intertrochanteric fractures.3 Intertrochanteric fractures with an intact lateral wall are stable enough to prevent excessive collapse and medialisation of the shaft. However, the presence of a lateral wall fracture converts a simple fracture to a reverse oblique fracture.4 Lateral wall thickness is defined as the distance from a reference point 3 cm below the vastus ridge or innominate tubercle of the greater trochanter angled at 135o upwards to the fracture line on anteroposterior radiographs. It is a reliable predictor for the risk of lateral wall fracture. If the lateral wall thickness is >20.5 mm, a sliding hip screw can be Commentary: Morphology and fixation pitfalls of a highly unstable intertrochanteric fracture variant

Which AO/OTA 31-A2 pertrochanteric fractures can be treated with a dynamic hip screw without developing a lateral wall fracture? A CT-based study.

To determine whether radiographic measurements derived from standard computed tomography (CT) evaluation can be used to predict likelihood of a peri-operative lateral femoral wall fracture in AO/OTA 31-A2 pertrochanteric fractures treated with a dynamic hip screw (DHS). Fifty-one patients with AO/OTA 31-A2 classified pertrochanteric fractures were evaluated using a pre-operative CT scan of the pelvis with both hips. Dimensions of the lateral wall were calculated for each patient using four parameters: (1) height of the lateral wall above the vastus ridge; (2) circumference of the lateral wall 2 cm below the vastus ridge at an angle of 135°; this circumference was further divided into an anterior, lateral and posterior component; (3) cortical thickness at the centre of the lateral component of the lateral wall; and (4) cortical index. All patients were treated with a 135° DHS. Postoperative radiographs were assessed for lateral femoral wall fracture. Patients with a lateral wall fracture (17/51) had a smaller circumference (4.47cm vs 5.44cm p value <0.001) as well as a lower height of the lateral femoral wall (1.37cm vs 2.21 p value < 0.001). Analysis of the three components of the circumference revealed a significant difference for the anterior component only and not for the lateral and posterior components. There was no statistical difference in the cortical thickness or cortical index in the two groups. The cutoff values for height of the lateral wall and anterior component were calculated using ROC curves and found to be 1.68cm (AUC 0.918) and 2.10cm (AUC 0.851)respectively. AO/OTA 31-A2 pertrochanteric fractures with a lateral wall height of > 1.68cm and an anterior component of > 2.10cm in circumference are not likely to sustain a lateral wall fracture when treated with a DHS.

Orbital fractures in children: 10 years’ experience from a tertiary centre

Our aim was to examine the relations between type and site of the fracture, age of the patient, and the management and outcomes, among children diagnosed with orbital fractures at the Women's and Children's Hospital, Adelaide, during a 10-year period from 1 January 2003 to 31 December 2012. The records of 41 children whose ages ranged from 8 months to 15 years were analysed. There was a male predominance (n=33). Two most common fractures were orbital floor and multiwalled fractures, with medial wall as the second most common site. The most common cause of injury was sport, more often with increasing age. In contrast, falls were more common among young children. Fractures of the orbital roof were more common among young children, all of ours being in children 10 years old or less. Lateral wall fractures were also more common among young children and declined in frequency with increasing age. In contrast, fractures of the orbital floor and medial wall can occur at any age, though those of the medial wall were more common among older children. As children grow their behaviour and activities change, and the mechanism by which they become injured also changes. Growth and development of the craniofacial skeleton lead to differences in the patterns of fractures with age. Fractures of the orbital roof and lateral wall are more common among young children, while those of the orbital floor and medial wall can occur at any age.

Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls

BackgroundFor AO/OTA 31-A2 fractures (A2 fractures) treated with dynamic hip screw (DHS), postoperative lateral wall fracture (PLWF) is thought to be a major cause of femoral medialisation and reoperation. Though trochanter stabilising plate (TSP) had been reported to have a good effect in preventing femoral medialization, its effects and indication in A2 fractures remain controversial. We hypothesized that TSP may improve treatment outcomes in patients with high risk of postoperative lateral femoral wall fractures. The purpose of this study was to investigate (1) the main risk factors predictive of PLWF in A2 fractures and, (2) whether TSP can improve treatment outcomes in patients with high risk of PLWF. MethodsTwo hundred and fifty-two A2 fractures treated with DHS or DHS and TSP (DHS–TSP) during January 2000 and June 2013 were enrolled in this study. Standard univariate and multivariate analyses were performed to determine statistically significant risk factors for PLWF in 205 patients who were treated with DHS alone. The risk factor found to be associated with PLWF was utilized to include 171 patients who were at high risk of PLWF. Standard univariate and multivariate analyses were performed to evaluate the effect of TSP on treatment outcomes. ResultsLateral wall thickness was found to be the main risk factor for PLWF in A2 fractures. A lateral wall thickness of 2.24cm was found to be the best cutoff point to determine which patients were at high risk for PLWF. In 171 patients with a lateral wall thickness less than 2.24cm, patients treated with DHS–TSP had significantly decreased lag screw sliding distances, PLWF rate, and reoperation rate (P=0.028, <0.001 and P=0.003, respectively) compared to the corresponding values of those treated with DHS alone. In the multivariate analysis, TSP decreased the reoperation rate by 13 times compared to that of patients who were treated with DHS alone. ConclusionLateral wall thickness is the main risk factor for PLWF in A2 fractures treated with DHS. Use of TSP in A2 fractures with critical thin lateral wall thickness <2.24cm can significantly decrease the lag screw sliding distances, PLWF rate and reoperation rate.

Early diagnosis of traumatic optic neuropathies combined with internal carotid artery injury

Objective To explore the methods of early diagnosis of traumatic optic neuropathies combined with internal carotid artery injury.Methods A retrospective study of 1 081 cases of traumatic optic neuropathy from Apr.2007 to Apr.2012 was performed.The CT angiography and/or magnetic resonance angiography were used as screening tools for the suspicious patients.The mechanisms of injury,clinical manifestations and neuroradiological features of internal carotid artery injury patients were discussed.Results In 1 081 cases of traumatic optic neuropathy,26 cases(2.4％)combined with internal carotid artery injury:12 cases were traumatic pseudoaneurysm,9 traumatic carotid cavernous fistula,4 traumatic pseudoaneurysm combined with carotid cavernous fistula,1 dural arteriovenous fistula.17 cases were treated by endovascular embolization,including detachable balloon technique in 10 cases,microcoils embolization in 7,and Onyx embolization in 1.The internal carotid artery was occluded in 7 cases.One intraorbital traumatic ophthalmic artery aneurysm was resected by cranio-orbital craniotomy.In the untreated team,2 cases died of hemorrhage.Conclusions For patients of traumatic optic neuropathies with unilateral blindness and posttraumatc epistaxis,if CT scan showed traumatic subarachnoid hemorrhage and fracture of the lateral wall of sphenoid sinus,CTA and/or MRA should be performed as the initial screening examination for internal carotid artery injury.As soon as a traumatic pseudoaneurysm was found,endovascular management should be initiated promptly. Key words: Traumatic optic neuropathies ; Traumatic subarachnoid hemorrhage ; Internal carotid artery ; Pseudoaneurysm

Predictors of iatrogenic lateral wall fractures while treating intertrochanteric fracture femur with the dynamic hip screw system in Indian patients.

The integrity of the lateral wall has been reported to be an important factor determining fracture stability in an intertrochanteric fracture. Iatrogenic the lateral wall fracture (ILWF) has been reported while reaming for the lag screw and the barrel of the dynamic hip screw (DHS). This study aimed to identify the predictors of iatrogenic lateral wall fractures (ILWF) while using the DHS, which will help to improve the pre-operative planning and avoid their incidence. A total of 120 adult patients with intertrochanteric fracture femur treated with the DHS were included in this prospective series. Pre-operatively, the parameters noted were the demographic data, quality of bone using Singh's index, fracture classification using AO/OTA and modified Evan's system. The incidence of ILWF was recorded immediately after the fixation with the DHS. The two groups, i.e. one with ILWF and other without ILWF, were compared. The mean age of 46 females and 74 men in the study was 61years. Among 120 patients, 87 (72.5%) patients had a posterior sag that had to be corrected while passing the guide wire and while reaming the neck of femur. The incidence of ILWF was 23.33%. The incidence of osteoporosis in patients with unstable fracture was 66.67%. 1.7% patients with a stable AO/OTA A1 fracture had ILWF, as compared to 50% of patients with type A2.2 and type A2.3 who sustained an ILWF (p<0.0001). None of the patients with a 2-part fracture on modified Evan's classification had ILWF, while 53.84% with a 4-part fracture had ILWF (p<0.01). There is a high risk of ILWF using the DHS in unstable intertrochanteric fractures (AO type A2.2 and A2.3 or 4-part fracture patterns). IV (case series).

Clinical Features and Treatment of Pediatric Orbit Fractures

To describe a series of orbital fractures and associated ophthalmic and craniofacial injuries in the pediatric population. A retrospective case series of 312 pediatric patients over a 9-year period (2002-2011) with orbit fractures diagnosed by CT. Five hundred ninety-one fractures in 312 patients were evaluated. There were 192 boys (62%) and 120 girls (38%) with an average age of 7.3 years (range 4 months to 16 years). Orbit fractures associated with other craniofacial fractures were more common (62%) than isolated orbit fractures (internal fractures and fractures involving the orbital rim but without extension beyond the orbit) (38%). Roof and medial wall fractures were most common (30% and 28%, respectively), followed by orbital floor (24%) and lateral wall (18%) fractures. Orbital roof fractures are the most common fracture in patients <8 years old, whereas orbital floor fractures are the most common fracture in patients older than 8 years. Eighty-seven patients (28%) underwent surgical repair. There is an increasing incidence of surgery in older patients (p = 0.02). Associated neurologic injuries were more common (23%) than associated ophthalmic injuries (20%). Pediatric orbit fracture patterns are dictated by the age of the patient with respect to their craniofacial morphology and mechanism of injury. Orbital roof fractures are more likely to occur in younger patients and not require surgery, whereas orbital floor fractures are more common in older patients and are more likely to require surgery.

Lateral Orbital Wall Fracture as a Mechanism of Blow-out Fracture in a Patient With Extensive Pneumatization of the Sphenoid Bone

We report a patient with a lateral orbital wall fracture that occurred as a result of a blow-out fracture. The patient has extensive pneumatization of the sphenoid sinus, and the air extends into the lateral orbital wall. It makes the lateral orbital wall much thinner unusually, being more vulnerable to a sudden increase in intraorbital pressure. Pure blow-out fracture of the lateral orbital wall has not been reported in the medical literature. Therefore, this is the first case report of a lateral orbital wall fracture occurring as a blow-out mechanism.

Ratio of Simple versus Comminuted Lateral Wall Fractures of the Orbit

Reduction of a fracture may be relatively easy with a simple, noncomminuted fracture along the zygomaticofrontal suture, zygomaticomaxillary buttress, or the inferior rim of the orbit. When one or more of these key landmarks is comminuted, it becomes more important to confirm that the fracture commonly seen between the greater wing of the sphenoid and the zygoma is properly repositioned. The zygomaticosphenoidal suture is an excellent landmark with a simple lateral orbital wall fracture (LOWF), but it may not be reliable in patients with a comminuted fracture. The purpose of this study is to determine the frequency that the lateral orbital wall (LOW) is a reliable landmark in the reduction of a zygoma fracture by determining the ratio between simple versus comminuted LOWF. To identify 100 patients with a LOWF, the authors reviewed consecutive midface computed tomography images of 877 patients performed over a 25-month period from one of our city's primary Level I trauma and teaching hospitals. A total of 121 LOWF were identified in 100 patients. In 60.3% of cases the facture was a simple, noncomminuted LOWF. In 39.7% of cases the fracture was comminuted (p = 0.023). Simple LOWF are significantly more common than comminuted fractures. In 39.7% of fractures the LOW is comminuted. This suggests that there are many fractures in which other modalities may be much more important to use to confirm the proper reduction of the zygoma.

Lateral femoral wall thickness

Although the importance of lateral femoral wall integrity is increasingly being recognised in the treatment of intertrochanteric fracture, little attention has been put on the development of a secondary post-operative fracture of the lateral wall. Patients with post-operative fractures of the lateral wall were reported to have high rates of re-operation and complication. To date, no predictors of post-operative lateral wall fracture have been reported. In this study, we investigated the reliability of lateral wall thickness as a predictor of lateral wall fracture after dynamic hip screw (DHS) implantation. A total of 208 patients with AO/OTA 31-A1 and -A2 classified intertrochanteric fractures who received internal fixation with a DHS between January 2003 and May 2012 were reviewed. There were 103 men and 150 women with a mean age at operation of 78 years (33 to 94). The mean follow-up was 23 months (6 to 83). The right side was affected in 97 patients and the left side in 111. Clinical information including age, gender, side, fracture classification, tip-apex distance, follow-up time, lateral wall thickness and outcome were recorded and used in the statistical analysis. Fracture classification and lateral wall thickness significantly contributed to post-operative lateral wall fracture (both p < 0.001). The lateral wall thickness threshold value for risk of developing a secondary lateral wall fracture was found to be 20.5 mm. To our knowledge, this is the first study to investigate the risk factors of post-operative lateral wall fracture in intertrochanteric fracture. We found that lateral wall thickness was a reliable predictor of post-operative lateral wall fracture and conclude that intertrochanteric fractures with a lateral wall thickness < 20.5 mm should not be treated with DHS alone.

The lateral radiograph is useful in predicting shortening in 31A2 pertrochanteric hip fractures.

We sought to determine if angulation or translation measured on the lateral preoperative injury radiographs of patients with 31A2 pertrochanteric fractures is related to excessive postoperative shortening when treated with a sliding hip screw. We retrospectively reviewed the radiographs of consecutive patients with hip fractures treated at a level I university trauma centre between 2003 and 2008. Patients with 31A2 pertrochanteric fractures treated with a sliding hip screw were identified through a search of medical records. The study variables were angulation and translation on the preoperative injury lateral radiograph. The outcome measure was radiographic evidence of fracture shortening, measured as the change in length of sliding hip screw visible outside the barrel between the time of fixation and final follow up. Of the 131 patients treated, 23 met our inclusion criteria and had sufficient follow-up (mean 6.4 mo). The average shortening for 31A2 fractures with angulation on the injury lateral radiograph was 1.83 (95% confidence interval [CI] 1.18-2.47) cm, compared with 0.93 (95% CI 0.49-1.36) cm for fractures with no angulation (p = 0.019). There was no statistical difference in quality of reduction, tip-apex distance, Orthopedic Trauma Association (AO/OTA) classification or incidence of lateral wall fracture across groups based on the presence of angulation. Angulation on the lateral preoperative injury radiograph may be useful in predicting excessive shortening in 31A2 pertrochanteric fractures. Further investigation is warranted to confirm this result and to identify the role of other predictors, such as fracture comminution.

An unusual case of intraorbital foreign body and its management

A 36-year-old aboriginal female presented following an assault with a wooden fence paling. Examination revealed a wooden object protruding lateral to the left eyebrow. CT scan showed a blow-in fracture of lateral orbital wall and a hypodense foreign body causing indentation of the globe and stretching of the optic nerve. The case was managed successfully with complete recovery of the visual acuity on day 1 post-surgery. This case highlights the importance of prompt removal of large lateral wooden intraorbital foreign body to achieve an excellent visual outcome.

Delayed Repair of Lateral Orbital Wall and Orbital Floor Fracture

Timing of surgical management of facial fractures may differ from the current standard when an associated severe ophthalmologic injury exists; this may necessitate a delay in repair to protect the patient's vision. We set out to demonstrate that good functional and aesthetic outcomes can be achieved in cases where zygoma bone fracture repair had to be delayed for more than 21 days after injury with a specific surgical plan.Using the electronic database from Montreal General Hospital, a level I trauma center, a retrospective review of all facial fractures occurring from 1994 to 2009 was performed. Our review returned a total of 22,727 trauma patients admitted to Montreal General Hospital. Of these, 2672 sustained 1 or more facial fractures. Among the facial trauma patients, 945 patients' injuries included a zygoma fracture, 324 (35.3%) of which were managed operatively. Seven cases had their surgery delayed for more than 21 days after injury, 2 of which were managed using simple osteotomies and plate fixations, without the need for bone grafts. Both patients demonstrated a satisfactory outcome with improvement relative to their preoperative status. We provide a detailed description of our most recent case of a 73-year-old woman in whom the surgical repair of the lateral orbital rim and orbital floor was delayed for 10 weeks to allow healing of her associated traumatic retinal detachment.For patients with associated ocular injuries who cannot undergo orbital fracture repair within 21 days of the trauma, delayed surgery may still result in an acceptable aesthetic result.

Tratamento das fraturas femorais subtrocantéricas com placas de bloqueio lateral da parte proximal do fêmur

OBJECTIVE: To study the outcome of subtrochanteric hip fractures treated with proximal lateral femur locking plate. METHOD: We retrospectively reviewed the clinical results of 48 cases of femoral subtrochanteric fractures treated with proximal lateral femur locking plates from January 2008 to May 2010. The progress of fracture healing, as well as the occurrence of complications, was recorded. The function of the hip joint was evaluated by the Harris social index and the Parker and Palmer mobility score one year after the operation. RESULT: 45 patients were followed up until fracture union or a revision surgery. Among the 45 patients, 43 patients obtained fracture union without further intervention. Thirty-eight fractures healed with no loss of position at 1-year follow-up. There were no cases of hip screw cutting through the femoral head. The mean score of the Harris social index was 86.5±9.8 (73~95). The mean Parker and Palmer mobility score was 7.4±2.1 (3~9). CONCLUSION: The proximal lateral femur locking plate is the kind of stable and effective internal fixation for treating subtrochanteric hip fractures which has the advantage of stable fixation especially for the lateral femoral wall fracture. Level of Evidence IV, Case Series.