title: Facial fractures with concomitant open globe injury: mechanisms and fracture patterns associated with blindness.
abstract: BACKGROUND
  Treatment of facial fractures in the setting of open-globe injuries poses a management dilemma because of the often disparate treatment priorities of multidisciplinary trauma teams and the lack of prognostic data regarding visual outcomes.
  
  
  METHODS
  Patients in the University of Maryland Shock Trauma Registry sustaining facial fractures with concomitant open-globe injuries from January of 1998 to August of 2010 were identified. Odds ratios were calculated to identify demographic and clinical variables associated with blindness, and multivariate regression analysis was performed.
  
  
  RESULTS
  A total of 99 patients were identified with 105 open-globe injuries. Seventy-nine percent of injuries were blinding, whereas 4.8 percent of globes achieved a final visual acuity greater than or equal to 20/400. Blindness was associated with penetrating injury, increasing number of facial fractures, zygomaticomaxillary complex fracture, admission Glasgow Coma Scale score less than or equal to 8, and globe injury spanning all three eye zones. Fracture repair was performed more frequently (62.5 percent) and more quickly (average time to fracture repair, 4.5 days) in cases of primary globe enucleation/evisceration when compared with complete (21.2 percent; 8 days; p=0.35) or incomplete (42.9 percent; 11 days; p=0.058) primary globe repair.
  
  
  CONCLUSIONS
  Penetrating injury mechanism and zone of eye injury appear to be better indicators of visual prognosis than facial fracture patterns. Given the high rates of blindness, secondary enucleation, and delay of fracture repair in patients that were not primarily enucleated, the authors recommend that orbital fracture repair not be delayed in the hopes of eventual visual recovery in cases of high-velocity projectile trauma.
  
  
  METHODS
  Risk, III.
authors: Baltimore, Md. From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine.
authors: Elbert E
authors: EE
authors: Vaca
authors: Gerhard S
authors: GS
authors: Mundinger
authors: Joseph A
authors: JA
authors: Kelamis
authors: Amir H
authors: AH
authors: Dorafshar
authors: Michael R
authors: MR
authors: Christy
authors: Paul N
authors: PN
authors: Manson
authors: Eduardo D
authors: ED
authors: Rodriguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D015353:Eye Enucleation; D017234:Eye Evisceration; D015807:Eye Injuries, Penetrating / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005147:Facial Bones / Q000293:injuries* / Q000601:surgery; D005151:Facial Injuries / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008396:Maryland; D008440:Maxillary Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D012887:Skull Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D014792:Visual Acuity; D055815:Young Adult; D015051:Zygomatic Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery