title: Combined Orbital Fractures: Surgical Strategy of Sequential Repair.
abstract: BACKGROUND
  Reconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS) is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes.
  
  
  METHODS
  We divided 74 patients who underwent the reconstruction of the orbital floor and medial wall concomitantly into a comminuted IMS group (41 patients) and non-comminuted IMS group (33 patients). In the comminuted IMS group, we first reconstructed the floor stably and then the medial wall by using separate implant pieces. In the non-comminuted IMS group, we reconstructed the floor and the medial wall with a single large implant.
  
  
  RESULTS
  In the follow-up of 6 to 65 months, most patients with diplopia improved in the first-week except one, who eventually improved at 1 year. All patients with an EOM limitation improved during the first month of follow-up. Enophthalmos (displacement, 2 mm) was observed in two patients. The orbit volume measured on the CT scans was statistically significantly restored in both groups. No complications related to the surgery were observed.
  
  
  CONCLUSIONS
  We recommend the reconstruction of orbit walls in the comminuted IMS group by using the following surgical strategy: usage of multiple pieces of rigid implants instead of one large implant, sequential repair first of the floor and then of the medial wall, and a focus on the reconstruction of key areas. Our strategy of step-by-step reconstruction has the benefits of easy repair, less surgical trauma, and minimal stress to the surgeon.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Su Won
authors.initials: SW
authors.lastname: Hur
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Kyu Jin
authors.initials: KJ
authors.lastname: Chung
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Tae Gon
authors.initials: TG
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Yong-Ha
authors.initials: YH
authors.lastname: Kim
keywords: Facial bones; Fractures, comminuted; Orbital fractures