Is the pure and impure distinction of orbital fractures clinically relevant with respect to ocular and periocular injuries? A retrospective study of 473 patients

Objective: To determine the association of "pure" orbital fractures (POF) and "impure" orbital fractures (IOF) with ocular and periocular injuries. Materials and methods: A retrospective study of patients with orbital fractures was designed. The predictor variable was the orbital's fracture configuration (pure versus impure). The primary outcome variables were ocular and periocular injuries classified as mild, moderate, and severe. The secondary outcome was the need for surgical repair. Standard statistics for patient characteristics, the Fisher exact test for categorical variables, and the Mann-Whitney U test for continuous variables were computed to compare fractures. Results: The sample was composed of 473 patients (220 POF and 253 IOF). No significant association between the two groups with regard to ocular and periocular injuries was found. Combined medial wall and floor fractures and naso-orbito-ethmoidal (NOE) fractures had the highest incidence of severe injury (34.5%, p = 0.02). Le Fort fractures were associated with moderate ocular and periocular injuries (36.4%, p = 0.01). Impure orbital fractures were more frequently associated with the need for surgical treatment (p = 0.04) than were POF. Conclusion: The present study has demonstrated that the pure and impure distinction of orbital fractures was not clinically relevant with respect to ocular and periocular injuries. However, our findings seem to suggest that other parameters such as the direction of the impact and/or its magnitude, rather than merely the pure or impure configuration, could be involved in determining the risk of developing concomitant ocular and periocular injuries. (C) 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.