Presentation and Management of Pediatric Orbital Fracture Subdivided by Fracture Location: A Systematic Review

Introduction: Orbital fractures are a rare fracture type in pediatric populations that can result in significant aesthetic and functional complications. This systematic review characterizes the presentations of these fractures and discusses how they are managed according to fracture location along the orbit.

Methods: A review in accordance with PRISMA and a search of MEDLINE, EMBASE, Cochrane CENTRAL, CINAHL, and Web of Science was performed. Studies evaluating the presentation and/or management of orbital fractures in pediatric patients where fracture location could be ascertained were included. Studies which only included patients managed surgically were included for surgical outcome analysis only.

Results: Among 2317 studies identified, a total of 27 studies were included. This cohort included 1183 patients with an average age of 7.88 years and a sex distribution of 70.9% males and 29.1% females. Orbital floor (N=547) and orbital roof (N=404) were the most common fractures in our dataset with medial wall, lateral wall, combined floor/lateral wall, and roof/medial wall also included (N=232). Sports injuries (31.0%) were the most common cause of orbital floor injuries, while falls (47.0%) were the most common cause of orbital roof injuries. The most common presenting symptom for patients with floor fractures was ocular motility limitation/diplopia (37.8%) while for roof fractures, patients commonly presented with intracranial/neurologic injuries (47.0%). Orbital floor fractures were more likely to be managed surgically (44.8%) than either orbital roof (13.5%) or other fracture types (21.1%). Among orbital floor fractures managed surgically, 76.2% had complete resolution of diplopia/ocular motility limitation.

Conclusions: With sports injuries and falls as common mechanisms of fracture and the potential for serious presenting symptoms based on fracture location, this study highlights the importance of appropriate activity-specific face and eye protection to prevent orbital fracture. Rates of surgery in these fractures differ depending on fracture location.