Characterization of orbital fracture patterns in head-injured patients using computed tomography

Objectives: Orbital wall fractures constitute approximately 85% of orbital traumas requiring hospitalization and nearly 40% of all craniofacial injuries. These fractures are typically classified according to the anatomical structures involved. This study aimed to assess the incidence and morphological patterns of orbital fractures in patients with head injuries, using computed tomography (CT) imaging to enhance diagnostic precision. Materials and Methods: This prospective observational study was conducted at a tertiary care institution and included 508 patients presenting with head injuries. The study focused on the frequency and types of orbital fractures as visualized through CT imaging, along with associated ocular and intracranial injuries. High-resolution CT scans (1.5–3 mm slice thickness) of the orbit and brain were obtained. Comprehensive ocular examinations were performed using slit lamp biomicroscopy and indirect ophthalmoscopy. Fractures were anatomically categorized based on CT findings, and traumatic brain injury (TBI) was evaluated in relation to the Glasgow Coma Scale. Results: Of the 508 patients, 80.4% were male. Road traffic accidents (RTAs) were responsible for 99% of the orbital fractures. The most frequently affected age group was 20–30 years, accounting for 38% of cases. Orbital fractures were identified in 153 patients (30%), with multiple wall fractures showing a strong association with TBI, present in 86% of those cases. The naso-orbito-ethmoid region was the most commonly involved fracture site. Subconjunctival hemorrhage was the most prevalent ocular finding. Zygomatico-orbital complex fractures were the most frequently observed isolated fractures, especially among patients with concurrent TBIs. Conclusion: Orbital fractures continue to represent a substantial source of morbidity among patients with head trauma, particularly in the setting of high-velocity mechanisms such as RTAs. Our study reinforces the strong association between multi-wall orbital fractures and the concomitant occurrence of both ocular injury and TBI, highlighting the intricate anatomical and functional interdependence of the orbit and neurocranial structures. Our study findings suggest that naso-orbito-ethmoid region fracture, due to their anatomical complexity and frequency, may serve as a clinical marker for more severe concomitant injuries. These findings underscore the necessity of a multidisciplinary management paradigm – one that brings together the expertise of neuro-ophthalmologists, neurosurgeons, maxillofacial surgeons, and neurologists – to ensure timely diagnosis, risk stratification, and coordinated care. Early recognition and intervention are paramount, not only to preserve visual function but also to mitigate the long-term neurological and esthetic sequelae inherent to complex craniofacial trauma.