Differences in demographic, etiologic, and clinical features between pure and impure orbital fractures

To analyze differences in demographics, etiology, and clinical characteristics between pure and impure orbital fractures (with or without orbital rim involvement) STUDY DESIGN: Retrospective observational study.

A total of 1104 cases of orbital fractures were reviewed. Fractures were classified as pure (881 cases) or impure orbital fractures (223 cases). Impure fractures were further subdivided into frontal bone (14 cases), zygomaticomaxillary complex (ZMC, 187 cases), and multiple (22 cases) fractures. Data on demographics, fracture types, injury mechanisms, field of binocular single vision (BSV), and associated ocular injuries were analyzed across the groups.

Patients with ZMC fractures were older than those with orbital or frontal bone fractures (P <.001 and P = .007). Bilateral fractures were more frequent in the multiple-fractures group (P <.001). Falls were the leading cause of injury (39%), particularly in ZMC fractures (52%). Motor vehicle accidents accounted for 50% of multiple fractures. The overall rate of ocular injuries was 7.3%, with all globe ruptures (5 cases) occurring in the pure fracture group. Multiple fractures had higher incidences of optic canal fractures and orbital compartment syndrome (P <.001). Frontal bone fractures demonstrated better BSV outcomes, whilst multiple fractures had the worst.

This large-scale study highlights the significant influence of age and injury mechanisms on orbital fracture patterns. Frontal bone fractures were associated with more favorable visual function, whilst pure fractures posed greater risk of globe rupture. These findings underscore the importance of tailoring management strategies to specific fracture types and patient demographics.