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Orbital roof fractures in childhood
M J Greenwald1, D Boston, J M Pensler
1Department of Ophthalmology, Northwestern University Medical School, Chicago, IL.
Insights
Orbital roof fractures are common in children, often resulting from minor falls. While acute neurological issues can occur, long-term vision and function are typically unaffected.
Area of Science:
- Pediatric Traumatology
- Ophthalmology
- Neurosurgery
Background:
- Orbital roof fractures are a significant injury in pediatric trauma.
- Understanding the epidemiology and clinical presentation is crucial for timely diagnosis and management.
Purpose of the Study:
- To document the incidence and characteristics of orbital roof fractures in children.
- To analyze fracture patterns, associated injuries, and clinical outcomes.
Main Methods:
- Retrospective review of 36 orbital roof fractures in 32 children over a 5-year period.
- Utilized computed tomography (CT) for fracture classification and assessment of associated injuries.
- Correlated clinical presentation with imaging findings and patient outcomes.
Main Results:
- 36 orbital roof fractures identified in 32 children.
- 16 isolated fractures (often linear, associated with minor trauma) and 20 complex fractures (often comminuted, with extensive skull damage).
- Upper eyelid hematoma was a common sign; no chronic visual or motility disturbances reported, though acute neurological concerns and two fatalities occurred. Two cases of late encephalocele were noted.
Conclusions:
- Orbital roof fracture is a frequent, yet often missed, pediatric injury.
- Age-related anatomical differences may influence injury patterns from frontal impacts.
- Most children experience good recovery, but vigilance for complications like encephalocele is necessary.
Abstract:
The authors documented 36 orbital roof fractures in 32 children over a 5-year period. With the aid of computed tomography (CT), 16 fractures were classified as isolated and 20 were found to be associated with more extensive damage to the skull. Isolated fractures typically occurred in younger children (mean age, 2.8 years) after relatively minor trauma, most often a fall from a height of less than 10 feet. Birth trauma was the cause in one case. Three fourths of the isolated fractures were linear; with extensive trauma, the orbital roof was usually comminuted. Upper eyelid hematoma characteristically developed hours after the traumatic event. There were no significant chronic disturbances of vision, motility, or lid function. Acute neurologic concerns were common, and two patients died, but full recovery was otherwise the rule. In two cases, late development of ocular pulsation led to CT demonstration of encephaloceles. Both of these children had comminuted roof fractures with displacement of bone fragments into the orbit. The authors conclude that fracture of the orbital roof is a common but frequently overlooked occurrence in childhood. Anatomic factors may account for differences in the effect of frontal impact at different ages.