Pediatric orbital fractures: classification, management, and early follow-up

Scarce literature exists addressing the presentation, classification, and management of pediatric orbital fractures. The aim of this study is to review the authors' experience with the presentation, management, and early follow-up of pediatric orbital fractures.

A retrospective review of pediatric orbital fractures presenting to the Children's Hospital of Pittsburgh between 2003 and 2007 was performed. Demographics, associated injuries, computed tomographic scan findings, management, and follow-up were collected. From these data, a pediatric orbital fracture classification system was devised.

Seventy-four patients (81 orbits) were reviewed. Average age at presentation was 8.6 years. Fractures were distributed as follows: type 1, 40.7 percent; type 2, 33 percent; and type 3, 25.9 percent. Twenty-three orbits were treated surgically and 58 were treated nonoperatively. The operative rates were as follows: type 1, 9.1 percent; type 2, 14.8 percent; and type 3, 76.2 percent. Complications included minor enophthalmos in seven patients, and persistent cerebrospinal fluid leak in two growing skull fractures. For type 1 (pure orbital) fractures, three (12 percent) underwent surgical treatment for acute enophthalmos, vertical orbital dystopia, or muscle entrapment. Twenty-two orbits (88 percent) were managed nonoperatively. At an average follow-up of 13 months, minimal enophthalmos (1 to 2 mm) was found in one of the surgically treated fractures (33 percent) and in three of the conservatively managed fractures (13.6 percent).

For type 1 (pure orbital) fractures, unless there is evidence of acute enophthalmos, vertical orbital dystopia, or muscle entrapment, a nonoperative approach is advocated. Type 2 (craniofacial) fractures should be followed with serial computed tomographic scans; and type 3 (common fracture patterns) fractures have a greater chance of requiring surgery.