title: Principles for Management of Orbital Fractures in the Pediatric Population: A Cohort Study of 150 Patients.
abstract: BACKGROUND
  Pediatric orbital fractures represent a challenging and sometimes controversial clinical problem. Patients may present with clear indications for surgery, but most require balancing benefits against intraoperative and late complications. The authors assessed these fractures at a state-designated ophthalmology referral center to develop criteria for surgery.
  
  
  METHODS
  Institutional review board approval was obtained to retrospectively analyze pediatric trauma registry patients with orbital fracture diagnoses at the Wilmer Eye Institute over 10 years. Patients were excluded if they did not undergo a full ophthalmologic examination, never followed up after their injury, or had significant facial fractures outside of the orbit.
  
  
  RESULTS
  One hundred fifty patients met selection criteria; 116 patients (77 percent) completed all follow-up (average, 309 days). Two patients had 20/40 vision or worse at the end of follow-up. One hundred ten patients (71 percent) underwent surgery; 96 underwent acute repair (<3 weeks) and 11 underwent delayed repair (median, 49 days). Three patients required reoperation, two for plate infection and one for hyperglobus, with an overall complication rate of 4.7 percent.
  
  
  CONCLUSIONS
  The authors analyzed the largest series of operative pediatric orbital fractures to propose criteria for surgical intervention. There are four potential indications: (1) rectus muscle entrapment; (2) early enophthalmos; (3) central-gaze diplopia or extraocular movement restriction after the resolution of swelling; and (4) loss of orbital support likely to produce secondary changes in globe position and/or binocular stereo vision. In our series, application of these principles offered excellent long-term aesthetic and ophthalmic outcomes with an acceptably low complication profile.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Baltimore, Md.|From the Department of Plastic Surgery and the Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins Medical Institutions.
authors.forename: Devin
authors.initials: D
authors.lastname: Coon
authors.affiliation: Baltimore, Md.|From the Department of Plastic Surgery and the Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins Medical Institutions.
authors.forename: Martin
authors.initials: M
authors.lastname: Kosztowski
authors.affiliation: Baltimore, Md.|From the Department of Plastic Surgery and the Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins Medical Institutions.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Mahoney
authors.affiliation: Baltimore, Md.|From the Department of Plastic Surgery and the Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins Medical Institutions.
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.affiliation: Baltimore, Md.|From the Department of Plastic Surgery and the Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins Medical Institutions.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Grant
authors.affiliation: Baltimore, Md.|From the Department of Plastic Surgery and the Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins Medical Institutions.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Redett
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009917:Orbital Fractures / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome