Most orbital roof fractures can be managed conservatively

Researchers characterized orbital roof fractures in adults who presented at a single level 1 tertiary care center between 2015 and 2018.

Study design

This retrospective study included 225 patients aged 15 years or older who had an orbital roof fracture and were admitted to a level 1 trauma center; 155 patients completed follow-up. The mean age was 45 years and 83% of patients were male. Fracture displacement, comminution and frontobasal type were determined from CT scans.

Outcomes

The study revealed that 52% of fractures were nondisplaced and 23% were minimally displaced. Approximately 12% of patients were diagnosed with traumatic optic neuropathy and 7% were diagnosed with retrobulbar hematoma. Eight patients underwent open reduction and internal fixation of their orbital roof fractures within 10 days of injury. Large fracture size (>4 cm³), ocular dysmotility and globe malposition were associated with patients undergoing surgical repair.

Limitations

This is a retrospective study with very short follow-up (median 1 month).

Clinical significance

This study is consistent with current teaching that the vast majority of orbital roof fractures can be managed conservatively. The indications for surgical repair include vertical dysmotility, globe malposition and large fractures. When these patients are encountered, it is important to remember that a significant portion have ocular injury that may lead to visual loss.