National Analysis of Surgical Intervention for Orbital Floor Fractures: Implications on Early Versus Late Repair

The timing of intervention for patients with orbital floor fractures is controversial. Some data suggest that symptomatic patients have improved outcomes with early surgery, whereas other studies demonstrate equivalent outcomes even if patients were observed for weeks to months. Our study aims to evaluate national trends and safety outcomes of timing of intervention for isolated orbital floor fractures.

From the Merative™ MarketScan® Research Databases, patients were queried from January 2007 to December 2022. ICD-9, ICD-10, and CPT codes were used to identify patients with orbital floor fractures, without entrapment, intracranial injuries, other face/skull fractures, or ocular injuries. Rates of enophthalmos and diplopia were examined relative to timing of intervention (no repair, early repair [≤2 weeks], or late repair [>2 weeks]).

Of the 75,882 patients identified, 11,728 were included in the study. The mean age was 39.11 years. A total of 174 (1.5%) presented with enophthalmos, and 721 (6.2%) presented with diplopia. Among the cohort, 9180 (78.3%) underwent no repair, 2043 (17.4%) underwent early repair, and 505 (4.3%) underwent late repair. Intervention was correlated with presentation of enophthalmos (OR, 7.960; P = 0.003) and diplopia (OR, 4.111; P < 0.001). Late versus early repair was not associated with presentation of enophthalmos (OR, 0.830; P = 0.453) or diplopia (OR, 0.956; P = 0.761). Provider specialty, specifically subspecialty providers, was significantly associated with undergoing early repair. At 1-year follow-up, enophthalmos and diplopia were diagnosed in 50 (0.5%) and 261 (2.8%) patients who underwent no repair, 87 (4.3%) and 296 (14.5%) patients who underwent early repair, and 24 (4.8%) and 70 (13.9%) patients who underwent late repair. Patients who underwent early repair were more likely to undergo revision surgery (OR, 0.245; P < 0.001). There were similar rates of enophthalmos and diplopia at 1-year follow-up between patients who underwent early repair versus late repair within the asymptomatic at day of injury cohort.

Decision to intervene on orbital floor fractures is strongly correlated with symptoms on initial presentation. From our analysis, rates of enophthalmos and diplopia were similar at 1-year follow-up. Early repair was associated with providers of surgical subspecialties and multiple repairs.