The value of computed tomographic scanning in the diagnosis and management of orbital fractures associated with head trauma: a prospective, consecutive study at a level I trauma center.
BACKGROUND
Orbital fractures associated with head trauma are not always easy to diagnose. The real incidence of such fractures is unknown. The aim of this study was to evaluate the usefulness of routine primary computed tomographic (CT) scanning for diagnosis of orbital fractures in head trauma patients.


METHODS
Over a 3-year period, 600 consecutive patients admitted with head trauma were examined clinically; these patients then underwent cranial helical CT scanning, irrespective of severity of head injuries and presence or absence of fracture-related symptoms.


RESULTS
Orbital fractures were diagnosed on CT scan in 118 cases (19.7%). All patients with symptoms directly related to an orbital fracture had radiologically diagnosed fractures, compared with 58.3% of patients with isolated blepharohematoma and 3.8% of asymptomatic patients.


CONCLUSIONS
CT scan of the orbits is indicated for any head trauma patient who presents either one or more symptoms directly related to an orbital fracture or just isolated blepharohematoma. CT scan of the orbits is not indicated in asymptomatic head trauma patients. Inclusion of the orbits in the scanning is recommendable only if a CT scan is already being obtained for a head injury. Clinical follow-up is important to detect any late-appearing symptoms. Accurate clinical examination still plays a crucial role in the diagnosis of orbital fractures.
Exadaktylos
Aristomenis K
AK
Institute of Anesthesiology, Inselspital, University of Berne, Berne, Switzerland.
Sclabas
Guido M
GM
Smolka
Koord
K
Rahal
Akram
A
Andres
Robert H
RH
Zimmermann
Heinz
H
Iizuka
Tateyuki
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000293:injuries*; D011446:Prospective Studies; D012887:Skull Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D013557:Switzerland / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*