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Characterizing Fracture Patterns, Management, and Adverse Outcomes: A Single Institution's Experience of 867 Pediatric Orbital Fractures
Alexander J. Comerci, BS
1,
2, Christopher Fedor, MS
1,
2, Viraj Govani, BA
1,
2, Zhazira Irgebay, MD, Nicolás M. Kass, BA
1,
2, Angel Dixon, BS
2, Megan Pencek, MD
2, Joseph E. Losee, MD
2, Jesse A. Goldstein, MD
2
1University of Pittsburgh School of Medicine, USA; 2Department of Plastic Surgery, UPMC Children’s Hospital of Pittsburgh, USA
Background: Pediatric orbital fractures present a unique challenge in clinical management due to the intricacies of facial skeletal development and the potential impact on visual function. While existing literature offers valuable insights, gaps persist in understanding the epidemiology, patterns, and outcomes of these fractures, particularly within a large-scale pediatric population. This study aims to address this gap by leveraging a robust pediatrics database to comprehensively explore the characteristics and management trends of pediatric orbital fractures.
Methods: A retrospective review was performed for all patients under 18 years of age who presented to Children's Hospital of Pittsburgh between 2006 and 2021. Demographic information, trauma mechanism, management strategy, and adverse outcomes were collected. Categorical variables were analyzed with Fisher exact tests. Logistic regression analysis was used to generate a predictive model for surgical intervention.
Results: Of 3,334 patients diagnosed with facial fractures, 867 had orbital fractures (28% were female). Average age of patients was 11.0 ± 5.0 years. Average follow-up was 17 ± 4.3 days. Surgery was performed in 23% of orbital roof fractures, 65% of orbital floor fractures, 40% of medial wall fractures, 16% of lateral wall fractures, and 12% of naso-orbital ethmoid fractures. The average time between incident and surgery was 3.35 ± 3.74 days, and was similar across age, gender, or race (p=0.168, 0.162, 0.565, respectively). The most common adverse sequelae were pneumo-orbit (28%), pneumocephalus (14%), and ptosis (11%). Adjusting for gender, there was a 113% increase in the odds of surgery when the patient was between 13 and 18 years (OR: 2.13 ; 95% CI: 1.57, 2.88; p<0.001).
Conclusion: Here, we provide a comprehensive characterization of the epidemiology and management of pediatric orbital fractures. Some specific fracture patterns and adverse sequelae provide clearer indications for which patients receive surgery, allowing us to develop a model to help prognosticate and improve patient care.
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