Forced duction training: A potential key point for recovery in pediatric patients with trapdoor fracture

Trapdoor fracture is a type of orbital fracture frequently observed in pediatric patients after facial trauma. The treatment options and surgical outcomes associated with this fracture are controversial.This study investigated the surgery principles and strategies as well as the functional training for the recovery and prognosis of pediatric patients with trapdoor fracture.A retrospective study was conducted on 21 pediatric patients with orbital trapdoor fracture who received the transconjunctival approach for orbital defect reconstruction surgery between 2009 and 2014 at the Department of Ophthalmology, Shanghai Ninth People's Hospital. The minimum follow-up period was 1 year, and the average follow-up time was 2.5 years. These data included surgery principles and strategies, functional training for recovery, and patient prognosis.Of all the numerical variables, interval to surgery was the only parameter that affected the recovery of ocular movement and diplopia grades [ΔLEMSG (6 m:pre) = -2.689 + 0.015 • interval to surgery, P = 0.018; ΔLEMSG (last:pre) = -3.171 + 0.026 • interval to surgery, P = 0.033; Δdiplopia (6 m:pre) = -3.266 + 0.026 • interval to surgery, P = 0.047; Δdiplopia (last:pre) = -2.518 + 0.019 • interval to surgery, P = 0.031], whereas recovery was not affected by age or preoperative ocular movement or diplopia grades (P > 0.05). According to the categorical variable analysis, patient prognosis grouped by coordination to forced duction training varied across the different groups (P < 0.05); however, male and female patients did not differ with regard to prognosis (P > 0.05).To judge the prognosis of pediatric patients with trapdoor fracture, cooperation to forced duction training and interval to surgery are most likely key points. Correct surgical approaches and functional training are of great importance for faster recovery.