Intracranial neurological injuries associated with orbital fracture

We attempted to define the central nervous system (CNS) concomitants of various types of orbital fractures in children by reviewing the records of 95 inpatients with admission diagnoses including orbital fracture who presented to the Children's National Medical Center from 1987 through 1994. Patients were divided into three age groups: group I: 0-5 years; group II: 6-12 years; group III: older than 12 years. Orbital fractures were classified by location: roof alone (A); orbital roof plus another orbital wall (B), and orbital fractures sparing the roof (C). Mechanisms of injury included falls (F), motor vehicle accidents (M), and blunt injuries (S). Admission Glasgow Coma Scale (GCS), neurosurgical intervention, nature of associated intracranial injury, and presence of residual neurologic deficit were recorded. Group I included 38 patients, while groups II and III included 28 and 29, respectively. There were 61 boys and 34 girls. Most fractures confined to the roof occurred in group I patients (12 of 16 fractures; 75%). Twenty-four of the 38 group I patients (63%) sustained orbital fractures involving the roof compared to 12 (43%) and 6 (21%) in groups II and III, respectively. Children with orbital fractures involving the roof and another orbital wall, regardless of age, had lower admission GCS. Over half of type B fracture patients (19/26) were involved in motor vehicle accidents. Intracranial injuries were identified in 26 of the 73 patients (36%) whose CT included the brain. Fifteen of 26 patients (58%) with intracranial injuries sustained fractures involving the orbital roof, but only 3 of these had a type A fracture. Seven of the patients with intracranial injury required emergent neurosurgical procedures. Younger children with maxillofacial injury sparing the orbital roof appear more likely to have coexisting intracranial injury, as reflected by CT findings and GCS on admission, than their older cohorts with similar injuries. Fracture of more than one orbital wall greatly increases risk of concurrent intracranial injury in all age groups.