Classification and Management of Infra-orbital Rim Fractures

Fractures of the infraorbital rim (IOR) are often undertreated with a resultant compromise of facial esthetics and function. The purpose of this research was to identify types of IOR fractures related clinical findings and assess post-treatment outcomes.

A retrospective cohort study was implemented involving all patients treated for IOR fractures during an 18-month period. Data consisted of treatment records, pretreatment and post-treatment photographs, and computed tomographic (CT) scans. The types of fractures were matched to the treatment instituted. The type of fracture was the independent variable, while the dependent variables were (i) clinical findings such as lid and globe malposition, tethering of facial skin, diplopia, and infraorbital nerve paresthesia, and (ii) treatment outcome assessed by surgeon and patient. Data were analyzed statistically to study frequencies, proportions, and associations using SPSS (v26, IBM, Armonk, NY).

Forty-three patients (41 males and 2 females) with IOR fractures were treated between July 2019 and January 2021. The age range was 18 to 50 years. The etiology for trauma in all patients was a motor vehicle accident. Fifty-one fractures were classified into 6 types based on CT presentation. The single line fracture (concomitant with other bones) was the most prevalent (58.8%), while globe malposition was the most common clinical finding (35.8%). Lid malposition, globe malposition, and tethering of facial skin were associated with the type of IOR fracture (P = .04, P = .02, and P = .01, respectively). Excellent outcomes were scored in 32 and 25 fractures by the surgeon and patients, respectively, (P = .015 and P = .003). The inter-rater agreement between the surgeon and patient was significant (Kappa = 0.680; P < .001).

Clinical findings in IOR fractures are dependent on the fracture type. Treatment of fractures based on their CT presentation produces effective management of signs/symptoms and improved treatment outcomes.