Etiology of orbital fractures at a level I trauma center in a large metropolitan city

Abstract

Background/Purpose:Orbital fractures are a common facial fracture managed by multiple surgical specialties. Methods: A retrospective review of the electronic medical records of patients (age, 18–85 years) presenting to Northwestern Memorial Hospital and Northwestern Medical Faculty Foundation in Chicago, IL, USA with International Classification of Diseases, Ninth Revision codes for facial fractures or CPT (Current Procedural Terminology) codes for orbital fracture repair.Results:A review of the electronic medical records identified 504 individual incidents of orbital fractures with available imaging for review. The most common location for an orbital fracture was a floor fracture (48.0%) followed by a medial wall fracture (25.2%). Left-sided orbital fractures were statistically significantly more common than right-sided orbital fractures (99% confidence interval). Orbital fractures were more prevalent in younger age groups. The mean patient age was 39.3 years. The most common cause of all orbital fractures was assault followed by falls. However, falls were the most common cause of orbital fractures in women and in patients aged 50 years and older. Evaluation by an ophthalmologist occurred in 62.8% of orbital fracture patients, and evaluation by a team comprising the facial trauma service (Otolaryngology, Plastic Surgery, and Oral and Maxillofacial Surgery) occurred in 81.9% of orbital fracture patients.Conclusion:Assault was the largest cause of all orbital fractures, and occurred most commonly in young males. Assaulted patients were more likely to have left-sided fractures compared to nonassaulted patients. In patients aged 50 years and older, falls were the most common cause of orbital fractures.

Review of Orbital Fractures in an Urban Level I Trauma Center

“…Our study showed that males in their fourth decade are the most common patients. Our male to female ratio was 3.3:1 which was comparable to previous studies reporting ratios of 2.3:1 in United States, 1 2.5:1 in Taiwan 2 , and 3.6:1 in Germany. 3 The most common racial group for orbital fractures were African Americans (63.6%).…”

“…Overall, our study found no significant difference in orbital fractures when differentiating by side. This was in contrast to studies by Chiang et al in 2016 2 and Chi et al, 10 who found that left-sided orbital fractures were more common than right orbital fractures. The literature also reveals that individuals who are assaulted are much more likely to have left-sided fractures compared to those who had an orbital fracture by a different mechanism of injury.…”

“…In contrast, Chiang et al conducted a similar review in Chicago, Illinois, and found that more Caucasians (56%) than African Americans (23%) had orbital fractures. 2 This is likely a result of population patterns in Atlanta and at GMH.…”

“…The most common mechanism of injury of orbital fractures at GMH was assault, which is consistent with other studies from major urban trauma centers in the United States. 1,2,4 The urban setting and GMH’s status as a level 1 trauma center are plausible explanations. Some other centers report MVCs are the most common etiology to orbital fractures.…”

“…This was in accordance with the study by Chiang et al in 2016. 2 Falls are considered as a low energy mechanism for facial fractures. Fall causes different patterns and less severe facial fractures.…”