title: Management of pure orbital floor fractures: a proposed protocol to prevent unnecessary or early surgery.
abstract: OBJECTIVE
  To present a case series review of management of pure orbital floor fractures and propose a protocol.
  
  
  METHODS
  A retrospective review of medical records and computed tomography (CT) scan findings was completed. Fractures were classified into either trap-door, floor-fracture with incarcerated tissue, or depressed floor-fragment fractures. Criteria for surgical success were: enophthalmos <1mm; no hypoglobus/hyperglobus; extra-ocular muscle restriction <5° in upgaze but normal in all other positions on Hess chart; and no diplopia other than in extreme upgaze (5°).
  
  
  RESULTS
  A total of 79 patients with orbital floor fractures were identified. There were 6 trap-door type fractures, 42 floor fractures with incarcerated tissue, and 31 depressed floor-fragment type fractures. Thirty-six patients were managed conservatively (antibiotics and observation). In nine of these, surgery was avoided by adhering to our protocol of delayed repair. Forty-three had surgical intervention: 6 were trap-door-type, 18 had a floor fracture with incarcerated tissue and 19 were of the depressed floor-fragment variety. All trap-door fractures underwent early repair (6/43, 14%), the rest had delayed repair (37/43, 84%). Four of 6 trap-door fractures had a successful outcome (66.6%). All 18 fractures with incarcerated tissue underwent successful delayed repair. Seventeen of 19 patients with depressed floor-fragment fractures were treated successfully surgically. The follow-up ranged from 12-64 months. The overall success rate was 85.3%.
  
  
  CONCLUSIONS
  Non-trap-door type of floor fractures can have a successful outcome with delayed repair. This can avoid unnecessary surgery in selected cases. A management protocol is proposed.
authors.affiliation: Deptarment of Ophthalmology, Norfolk and Norwich University Hospitals NHS Trust , Norwich , United Kingdom and.
authors.forename: Bijan
authors.initials: B
authors.lastname: Beigi
authors.forename: Mona
authors.initials: M
authors.lastname: Khandwala
authors.forename: Deepak
authors.initials: D
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D013508:Ophthalmologic Surgical Procedures; D009917:Orbital Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures
chemical_list: D000900:Anti-Bacterial Agents
keywords: Delayed repair; orbital floor fracture repair; trap-door fracture