Management Strategies for Isolated Medial Orbital Wall Fractures: A Literature Review of Surgical and Conservative Approaches

Purpose: We reviewed the literature on the management of isolated medial orbital wall fractures to understand when patients are treated surgically or conservatively, and their postoperative complications. Methods: A comprehensive search was conducted in Cochrane, Medline, and Embase databases on 11/1/2020 with the date range of January 1960 to July 2019 to find published systematic reviews, case series, and clinical research articles. A total of 1321 articles were reviewed, of which 55 papers met our inclusion criteria, and the analyzed papers included 44 case series and 11 case reports. All statistical analyses were performed using R open-access statistical software with a P -value of <0.05. Results: Medial rectus involvement upon initial presentation was statistically different between surgical and conservatively managed groups (1±0.4 versus 0±0, P =0.008). When analyzing postoperative symptom differences among 738 surgically treated patients and 214 conservatively treated patients, most experienced no symptoms (79.1% versus 85.0%, ns). Diplopia was the most common postoperative complaint for the surgically treated group (10.3%), whereas enophthalmos was the most common in the conservatively treated group (8.4%). Surgically managed patients had a higher incidence of diplopia (29.8%±6.7% versus 3.7%±2.3%, P <0.01) and concomitant injuries (15.2%±5.6% versus 0.0%±0%, P =0.01). Conclusion: Although surgical and conservative groups had similar postoperative courses, the initial presentation of these groups differed from each other. These differences in the presentation can help guide practitioners in making clinical decisions on whether to treat their patients surgically or conservatively.