[Operation indications of blow-out and midface fractures]

89 patients with fractures of the orbital floor - both in isolation (blow-out fractures) and combined with a complex fracture of the midregion of the face - were followed up for an average of 5 years. Particular attention was paid to the quantitative evaluation of binocular fusion, diplopia and enophthalmos. Comparison of operated and conservatively treated patients with blow-out fractures led to the following conclusions with regard to indications for surgery: 1. It is not justified to regard either surgery or its postponement pending developments as obligatory in all cases. 2. Surgery is indicated by clinical, orthoptic and roentgenological findings as follows: a) In case of enophthalmos or roentgenological demonstration of prolapse, surgery is indicated independent of diplopia. b) Diplopia outside the main field of view does not, in general, necessitate surgery. c) If there is diplopia within the main field of view, surgery is indicated. It is generally accepted that orbital-floor fractures associated with complex mid-face fractures require early surgical treatment. The present investigation confirms this view.