Orbital Floor Fractures Concurrent with Acute Open-Globe Injuries

5 Apr 2021

Aditya Uppuluri, Neelakshi Bhagat, Paul D. Langer

Journal : Ophthalmology

Ref : Open globe injury Orbit Orbital floor fracture

Characteristics of Orbital Floor Fractures in the United States from 2006 to 2017

5 Mar 2021

Mustafa Iftikhar, Joseph K. Canner, Leangelo Hall, Meleha Ahmad, Divya Srikumaran, Fasika A. Woreta

Purpose

To examine the incidence, characteristics, and economic burden of orbital floor fractures in the United States.

Design

Retrospective, longitudinal study of the Nationwide Emergency Department Sample (NEDS).

Participants

Patients in the Emergency Department (ED).

Methods

The NEDS, a representative sample of all hospital-based EDs in the US, was used to identify and describe ED visits with a primary diagnosis of orbital floor fracture from 2006 to 2017. Linear regression was used to estimate the trends in annual incidence and inflation-adjusted ED charges. Logistic regression was used to assess variables associated with inpatient admission.

Main Outcome Measures

Incidence, injury mechanisms, demographics, clinical characteristics, disposition, and economic burden.

Results

From 2006 to 2017, there were an estimated 350 379 ED visits in the US with a primary diagnosis of orbital floor fracture. The incidence increased by 47% over the study period ( P < 0.001): from 7.7 (95% confidence interval [CI], 6.9–8.5) to 11.3 (95% CI, 10.0–12.6) per 100 000 population. The majority were male (67%), aged 21 to 44 years (46%), and from low-income households (32%). The most common cause was assault (43%), which was most frequent in young adults (65%) and increased modestly over time (3.5 to 4.5 per 100 000 population; P = 0.02). The second most common cause was falls (26%), most frequent in patients aged ≥65 years (86%) and more than doubled over time (1.6 to 3.5 per 100 000 population; P < 0.001). The rate of inpatient admission was 14%, with a higher likelihood for patients aged ≥65 years (odds ratio [OR], 2.21; 95% CI, 1.99–2.46; P < 0.001) and falls (OR, 1.54; 95% CI, 1.27–1.86; P < 0.001). The total inflation-adjusted ED charges over the study period exceeded $2 billion, with the mean charge per visit increasing 48% ( P < 0.001): from $5881 (95% CI, 5499–6263) to $8728 (95% CI, 8074–9382).

Conclusions

Orbital floor fractures are becoming an increasingly common and costly injury in the United States. Preventive strategies aimed at reducing assault and falls will be crucial to mitigate the burden of orbital floor fractures on the healthcare system.

https://www.aaojournal.org/article/S0161-6420(20)30676-X/fulltext

Journal : Ophthalmology

Ref : Orbit Orbital floor fracture Orbital trauma

Prediction of late displacement of the globe in orbital blowout fractures

20 Mar 2020

Yongrong Ji, Yixiong Zhou, Qin Shen, Wei Xu, Shengfang Ge, Lixu Gu, Xianqun Fan

Purpose

To establish a linear measuring method in computed tomographic (CT) images to predict the displacement of the globe late after orbital blowout fracture.

Methods

Subjects were retrospectively included. Inclusion criteria were as follows: (1) adult subjects (≥18 years old at the time of trauma); (2) unilateral orbital medial‐wall and/or floor fractures; (3) CT examination at least 30 days after trauma. Exclusion criteria were as follows: (1) facial or orbital fracture extending to other parts of the orbit than medial‐wall and/or floor; (2) history of orbital or ocular abnormality other than the orbital trauma; (3) severe ocular trauma accompanied by the orbital trauma; (4) orbital fracture treated surgically before the CT examination. A co‐ordinate system was built based on the orbital CT scans. Displacements of orbital walls, displacement of the globe and relative location of the fracture site were measured. Correlations between the variables were investigated.

Results

Ninety‐nine per cent of fracture sites of the medial wall and 100% of fracture sites of the floor were posterior to the centre of the unaffected globe. The affected globe moved significantly medially (p < 0.001) and backwards (p < 0.001) in pure medial‐wall fracture; backwards (p < 0.001) and downwards (p = 0.017) in pure floor fracture; and medially (p < 0.001), backwards (p < 0.001) and downwards (p < 0.001) in medial‐wall and floor fractures. Displacement of the globe was correlated with displacements of the orbital walls, and the regression formulae were therefore fitted. Application of the formulae revealed that the same extent of orbital wall displacement caused more displacement of the globe in female patients than in male patients.

Conclusions

A linear measuring method in a three‐dimensional co‐ordinate system was established to identify the displacements of orbital walls and the displacement of the globe in orbital blowout fractures. The regression formulae generated in this study might be used in clinical practice to predict late displacement of the globe by measuring the displacements of orbital walls.

https://onlinelibrary.wiley.com/doi/10.1111/aos.14226

Journal : Acta Ophthalmologica

Ref : Enophthalmos Orbit Orbital floor fracture Orbital fracture Orbital trauma