Seasonal trends in baseball- and softball-related pediatric orbital fractures

To investigate the seasonality of sports-related orbital fractures in young athletes with particular focus on baseball and softball.

The medical records of pediatric patients (<18 years of age) treated for sports-related eye injuries at a single tertiary care facility from January 2009 to December 2024 were reviewed retrospectively. Patients with ICD-10 diagnosis codes related to orbital fracture and evaluated by the ophthalmology service were included. Demographics, types of sport, orbital fracture patterns, symptoms, and timing of initial encounter were extracted from the record. Fractures were grouped by conventional seasons of the year with only complete season-years, defined as one fracture in any given month of a season, included in the final analysis. Friedman rank-sum test was used to determine seasonality. Proportions of fracture counts were compared using the t test, with significance set at P < 0.05.

Of 573 patients meeting inclusion criteria, 129 (22.5%) had sports-related orbital fractures, of which 110 (85.3%) were related to baseball and softball. Five complete season-years were included in the final seasonal analysis. This cohort demonstrated significant seasonality (P = 0.030) although pairwise comparisons of spring versus other seasons did not reach significance. Spring demonstrated a significantly higher proportion of fractures (43.1%) than expected if fractures were equally distributed at 25% (P = 0.006).

Baseball- and softball-related orbital fractures can be predictable and seasonal as the spring season arrives. Eye care providers can proactively advocate for young athletes to wear appropriate head and eye protection to reduce increased fracture risk.