Outcomes and prognostic factors in pediatric orbital trapdoor fracture: a multi-center study

Abstract

Purpose To evaluate clinical presentations, computed tomography (CT) findings, and various prognostic factors affecting the surgical outcomes of trapdoor fractures. Methods This retrospective multi-center study reviewed medical records and orbital CT scans of patients under 21 years old, diagnosed with isolated trapdoor fractures. The study was conducted across multiple medical centers, including emergency and clinical departments in Isfahan, Shiraz, and Tehran-Iran. The characteristics and outcomes following surgical intervention were assessed. Results 45 patients with isolated trapdoor fractures were included in the study, with a mean age of 11.67 +/- 4.69 years, predominantly male (84.4). Vehicle accidents was the major cause of fractures (31.1). 44 patients (97.8) had orbital floor fracture, and one patient (2.2) had medial wall involvement. Nausea/vomiting were reported in 41 patients (91.1). Surgical intervention within 2 days, resulted in 85.0 of patients experiencing no postoperative diplopia. Delayed surgery beyond 2 days showed increased odds of diplopia, although not statistically significant. CT scan findings suggested a lower risk of diplopia in patients with soft tissue entrapment compared to muscle involvement (OR: 0.336, 95 CI: 0.077-1.462, p = 0.146). Shorter time to surgery (within 2 days) was significantly associated with normal postoperative eye movements (p = 0.002). Nausea/vomiting were more prevalent in patients with muscle entrapment (p < 0.05). Conclusion Surgical intervention within 48 h is crucial for improving ocular motility following trapdoor fractures. Extraocular symptoms, including nausea/vomiting, should raise suspicion for trapdoor fractures in cases of orbital trauma associated with ocular movement impairment.