In this presentation from the 2012 Annual Meeting, Dr. Ron Pelton discusses the challenges of large orbital fractures that include both the medial wall and floor. If only the floor fracture is repaired, the patient is at risk of severe enophthalmos or diplopia. While placing 2 plates can be difficult, putting in 1 plate to span both fractures is even more challenging. Dr. Pelton presents techniques to address both the medial wall and floor fracture so that both are adequately plated, demonstrating a transcaruncular approach to the medial wall and his technique to avoid disinsertion of the inferior oblique.