This is a retrospective study of 30 patients between three and 14-years-old, recruited between January 2008 to September 2016, who underwent surgery for trapdoor fractures. Two groups were evaluated: Group A- 17 patients with muscular entrapment, Group B- 13 patients with soft-tissue entrapment. Severe motility restriction was found in 12 patients (seven in Group A) and mild type of restriction in 18 (10 in Group A) preoperatively. Postoperatively, 41.7% recovered from severe restriction, and 83.3% from the mild restriction group. However, four (23.7%) in Group A (all with severe restriction) and six (46.2%) in Group B (half with severe restriction) remained with persistent diplopia. The authors recommended that due to a long recovery time and high percentage of persistent diplopia in this group of delayed trapdoor fracture in children, a prompt surgery within 48 hours is strongly recommended in patients with muscular entrapment, and for those with soft tissues entrapment and significant motility restrictions patients. In other patients without such indications, even though some recovery might be possible in the long term, a prompt surgery after diagnosis is still preferable regardless of the entrapment contents.

Delayed surgical treatment of orbital trapdoor fracture in paediatric patients.
Su Y, Shen Q, Bi X, et al.
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Jonathan Chan

Royal Hallamshire Hospital, Sheffield, UK.

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