Comparison of Reconstructive Materials in Paediatric Orbital Fractures: A Systematic Review

Area of Science:

• Ophthalmology
• Plastic Surgery
• Biomaterials Science

Background:

• Paediatric orbital fractures necessitate precise reconstruction to avoid lasting functional and aesthetic issues.
• Material selection for pediatric orbital fracture repair presents unique challenges due to anatomical and developmental factors specific to children.
• Current comparative data guiding implant material choices for pediatric orbital reconstruction are limited.

Purpose of the Study:

• To systematically review and compare the outcomes and complications of various implant materials used in paediatric orbital fracture reconstruction.
• To identify trends in material usage and associated sequelae in pediatric orbital fracture repair.

Main Methods:

• A systematic literature search was performed across PubMed, Scopus, Web of Science, and Embase up to February 2025.
• Studies reporting outcomes (diplopia, enophthalmos, restricted eye movements, material removal, return to theatre) for pediatric orbital fracture implants were included, adhering to PRISMA guidelines.
• Data from 54 studies involving 562 patients and 563 implants were analyzed, categorizing materials into polymers, alloplasts, autologous, allografts, xenografts, and metals.

Main Results:

• Polymers (n=169), alloplasts (n=167), and autologous (n=166) implants were most frequently used.
• Late postoperative diplopia rates were 7% for polymers and 6% for alloplasts, significantly lower than allografts (29%), xenografts (24%), and metals (33%).
• Infection, material removal, and return to theatre rates were low (1-4%) across all material groups; enophthalmos was highest in the autologous group (8%) but inconsistently reported.

Conclusions:

• Polymers and alloplasts appear to be favorable options for pediatric orbital fracture reconstruction regarding late diplopia.
• While short-term complications like infection and material removal are low across most materials, robust studies with standardized outcomes and follow-up are essential for evidence-based material selection.
• Further research is needed to establish definitive guidelines for optimal material choice in pediatric orbital reconstruction.