Assessing the need for specialty consultation for isolated medial orbital wall fractures

This objective was to assess if the current practice of interfacility transfer and immediate specialty consult is justified by the rate of surgical repair for isolated medial orbital wall fractures.

This is a retrospective descriptive study utilizing the records of all patients with isolated medial orbital wall fractures who presented to the ED at Boston Medical Center from January 2014 to December 2022. A descriptive analysis was completed.

A total of 65 patients with isolated medial orbital wall fractures were identified. No patient underwent surgical intervention for repair of their fracture. 15% of the patients were transferred from an outside facility. The facial trauma team was consulted for 70% of the patients. Concomitant consultation of the ophthalmology and facial trauma teams occurred for 54% of the patients. Patients with no specialty consult had the shortest average length of ED stay. The no-show rate for follow-up appointments was 70%.

The absence of surgical repair for isolated medial orbital wall fractures across multiple surgical specialties, multiple attending providers, a wide age range, and all mechanisms of injury along with a 70% follow-up no-show rate may call into question the conventional approach of interfacility transfer and immediate specialty consult for these fractures.