Predictors of diplopia in pure orbital blowout fracture – a restropective study

Abstract

Orbital blowout fractures (OBF), especially pure OBF, are not uncommon and may have serious clinical implications, including functional deformities such as diplopia. Early prediction of diplopia among adult patients with pure OBF is essential in assisting in surgical indication and timing of fracture reconstruction. A combination of assessment from clinical investigation for diplopia and imaging by using computed tomography (CT) scan is essential to detect and evaluate pure orbital fracture. In Malaysia, there is no previous study that evaluates the relationship between clinical investigation and CT scan characteristics with the occurrence of diplopia in pure OBF adult patients. This retrospective cross-sectional study analysed all clinical records and CT data of patients who sustained pure OBF from 1st January 2008 to 28th February 2022 from a single tertiary hospital in Klang Valley. Data from 70 of cases have been identified and included for the study. Parameters that were assessed include Hess area ratio percentage, HAR% from clinical investigation and various radiographical characteristics, and their association with posttraumatic diplopia. Demographically, data showed motor vehicle accident (MVA) was the main aetiology of the fracture, with males outnumbered female patients. Orbital floor was noted as the most common fracture site. An analysis showed moderate to strong significant association between Hess area ratio < 85%, continuous inferior and medial fracture, fracture size > 3.00 cm2, fracture type III and 2 points muscle contact with posttraumatic diplopia with p- value < 0.05 and Phi-Cramer V > 0.4. Hess area ratio less than 85% and fracture type III were predictors for diplopia in pure OBF. It can be concluded that parameters from both clinical investigations (HAR < 85%) and radiographical characteristics (Fracture Type III) were important to predict the occurrence of diplopia in pure OBF patients in acute setting. New finding of inverse relationship between fracture size and HAR% were also found in this study.