A study of sports-related orbital fractures in Singapore

Pediatric orbital fractures in Singapore: demographics, etiology, and the role of bioresorbable implants

Purpose

This study aimed to analyze the demographic characteristics, etiology, fracture types, interventions and treatment outcomes, with a focus on the increasing role of bioresorbable implants compared to traditional non-resorbable implants in pediatric orbital fractures.

Methods

This was a retrospective cohort study conducted at the Department of Ophthalmology, National University Hospital, Singapore, of pediatric patients (aged 18 years or younger) treated surgically for orbital fractures from January 2005 to May 2023. Data was extracted from the hospital's electronic medical records, including demographic details, causes of fractures, types of fractures, implants used (bioresorbable and non-bioresorbable), and clinical outcomes.

Results

43 cases of pediatric orbital and orbitofacial fractures met the criteria undergoing surgical intervention. Most occurred in males (81.4%, n=35). Causes of fractures were sports-related incidents and play (46.5%, n=20), assault (30.2%, n=13), road-traffic accidents (16.3%, n=7), and non-play related accidents (7%, n=3). Most pediatric orbital fractures were unilateral (88%, n=38). While most were pure or simple orbital fractures (74.4% n=32), 25.6% (n=11) were complex orbitofacial fractures. Amongst simple orbital fractures, blowout fractures (91%, n=29) were the most common, involving the inferior (58.6%, n=17), combined floor and medial wall (20.6%, n=6), medial wall (13.8%, n=4) and roof (6.9%, n=2). Amongst the complex fractures, zygomaticomaxillary complex fractures were the most frequent (45.4%, n=5), followed by cranioorbital fractures (27.3%, n=3) and Le Fort II & III fractures (27.3%, n=3). Orbital tissue entrapment was common (56%, n=24), and most patients with entrapment underwent urgent surgical intervention (65%, n=28), usually within 24 hours (53%, n=23). The majority of those who underwent surgery had implants placed (89%, n=25), with most being bioresorbable (64.3%, n=18). All patients (100%) who underwent surgery showed clinical improvement without significant complications.

Conclusion

Although simple pediatric orbital blowout fractures are still the most common among pediatric patients, the study showed that a quarter of them presented with complex orbitofacial fractures requiring multidisciplinary management. Most fractures occurred in males and typically associated with increasing play and physical activity in teenagers. The study also showed that early intervention is crucial to better outcome, with the increasing role of bioresorbable implants in this population reducing long term implant related complications.

Patterns of Orbital Fractures Caused by Sports Injuries in Children

BACKGROUND

Sports injuries account for 11.3 to 42.1% of the facial fractures. Injuries from contact with a ball, a bat or stick, or another player raise safety concerns.

PURPOSE

The purpose of this study was to assess the patterns of sports-related maxillofacial injuries involving orbital bone fractures in children.

STUDY DESIGN, SETTING, AND SAMPLE

This was a retrospective case series of children who presented to Children's Healthcare of Atlanta from 2015 to 2021, with orbital injuries resulting from sports.

INDEPENDENT VARIABLE

None.

OUTCOME VARIABLE

The outcome variables, including the fracture location, pattern, and the management of injury.

COVARIATES

The medical record were reviewed for the following variables: 1) demographic information, 2) mechanism of injury, 3) type of sport, 4) symptoms, 5) length of inpatient stay, and 6) duration of follow-up.

ANALYSIS

Data were collected using a standardized collection form. Descriptive statistics were calculated.

RESULTS

Overall, 101 patients (92 males) with an age of 13 ± 3 met the inclusion criteria. The most common sport was baseball or softball (n = 78, 77.2%). The mechanisms of injuries were largely due to collision with the ball (n = 79, 78.2%) or with another player (n = 13, 12.9%). Orbital fractures occurred mostly in the floor (n = 87, 86.1%), followed by the medial wall (n = 22, 21.8%), with an average of 1 surface involved. Maxillary sinus (n = 23, 22.8%) and/or nasal bone (n = 17, 16.8%) were the other facial bones outside of orbit commonly injured. The fractures patterns are minimally/nondisplaced (n = 68, 67.3%), displaced (n = 30, 29.7%), or comminuted (n = 3, 3%). The managements include surgical and nonsurgical. Twenty-three patients (22.8%) underwent surgical intervention. Twelve of them had an emergent operation due to extraocular muscle entrapment.

CONCLUSION

Sports injuries are a common cause of orbital trauma in children. Most injuries are due to baseball/softball from collision with the ball. They were mostly managed without surgery, except for the individuals that presented with entrapment, oculocardiac reflex, and a large-size defect. The information from this project could be utilized in implementing safety equipment use for participants to further prevent such injuries.

Sports-Related Pure Orbital Blowout Fractures in Japan: Differences in Demographic and Clinical Characteristics between Sports

The aim of this study was to present the demographic and clinical characteristics of sports-related pure (rim-sparing) orbital blowout fractures and to analyze these differences by type of sport. Ten years of sports-related orbital fracture data were accumulated. Patients were classified into similar sports (i.e., soccer and futsal) wherein orbital blowout fractures were obtained, producing 14 groups. This study included 377 sides from 374 patients. The majority of patients were male (83.4%), and the mean population age was 20.9 ± 10.8 years. The most common sports causing injuries were baseball/softball, rugby/football, and martial arts. Single-wall fractures were found in 78.8% of patients, but baseball/softball had a higher frequency of multiple-wall fractures (p = 0.035). Concomitant ocular and periocular injuries occurred in 18.6% of patients, which were frequently caused by baseball/softball (p < 0.001). The field of binocular single vision (BSV) included primary gaze in 84.2% of patients. Surgical management was conducted in 52.1% of patients. This study showed that baseball and softball had the highest rate of multi-wall fractures and concomitant ocular and periocular injuries. The field of BSV measured during the first examination was acceptable in most cases.

Epidemiology of Sports-Related Eye Injuries Among Athletes in Tianjin, China

Purpose: To investigate the incidence, characteristics, and risk factors of sports-related eye injuries among athletes in Tianjin, China.

Methods: A cross-sectional study was carried out from March 2018 to October 2018. In this study, the athletes from Tianjin University of Sports, Tianjin Vocational College of Sports, and Tianjin provincial sports teams were selected for general investigation. In total, 1,673 athletes were invited and 1,413 participated in the study (response rate of 84.5%).

Results: In total, 1,413 athletes were enrolled; 151 had suffered from sports-related eye injuries, with an incidence of 10.7% (95% CI: 9.1–12.0%). Handball (38.5%) was the sport with the highest incidence of eye injuries, followed by water polo (36.4%) and diving (26.7%). Overall, 42.4% of the athletes were injured by ball and 22.5% of injuries came from teammates. The eye injuries usually occurred during training (64.2%) and competitions (14.6%). Adnexa wound (51.7%) was the most common type of injury. About 11.9% of the athletes with eye injuries had the impaired vision; 66.7% failed to see doctors on time. The athletes <18 years of age had a higher risk of eye injuries (odds ratio [OR] =1.60, 95% CI: 1.06–2.40). The athletes with lower family income (<1,000 RMB) were at risk population for sports-related eye injuries (OR = 3.91, 95% CI: 2.24–6.82). Training >4 h a day increased the risk of eye injuries (OR = 2.21, 95% CI: 1.42–3.43).

Conclusion: The incidence of sports-related eye injuries among athletes was 10.7% in Tianjin, China. Handball, water polo, and diving were the most common activities of injury. Age, family income, and training time were the risk factors for sports-related eye injuries.

Ocular Related Sports Injuries

ABSTRACT

Ocular injuries occur frequently in sports, affecting the globe, surrounding soft tissues, and the orbital bony structure. This review provides the craniofacial surgeon a broad general overview of epidemiology, mechanism of disease, and prevention.

Facial Fractures Related to Soccer: A Review

ABSTRACT

Soccer is one of the most popular sports in the world. Despite the concept that soccer is not a violent game, it can lead to several injuries in amateur and professional settings, including facial fractures. Previous studies of facial fractures in soccer were all retrospective and, to date, no prospective studies are available in the literature.The authors performed a comprehensive literature search using the terms "soccer" AND "facial fracture" OR "craniofacial fracture" and "football" AND "facial fracture" OR "craniofacial fracture" and retrieved 693 articles. After applying inclusion and exclusion criteria, 11 articles were included in the present study.A total of 647 patients had suffered facial trauma, with a male-to-female ratio of 63.7:1. The patients' mean age was 27.3 years.The articles reported 670 fractures as follows: 219 (32.7%) in the zygoma, 197 (29.4%) in the nasal bone, 153 (23.6%) in the mandibula, 54 (8.0%) in the orbital wall, 12 (1.8%) in the frontal sinus, 10 (1.5%) in the alveolar bone, 3 (0.4%) in the maxilla, 3 (0.4%) in a Le Fort pattern, and 1 (0.1%) in a naso-orbito-ethmoid (NOE) pattern.Sports are a frequent cause of maxillofacial trauma and are responsible for 9.2% to 33.2% of such injuries. Soccer is a contact sport more associated with lower-limb injuries, but with a significant rate of facial fractures. As soccer is a popular sport played without facial protection and involving high-intensity movements and contact, the prevention of facial fractures related to this sport is crucial to improve the players' safety.