ArticleJournal of trauma and injury2025
Thirteen-year trend analysis of orbital blowout fractures: shifts in mechanisms and ocular sequelae across two Korean trauma centers (2011-2023).
Article in Journal of trauma and injury, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to examine 13-year changes in the injury mechanisms of orbital blowout fractures (OBFs) in Korea and to determine how those changes influenced preoperative ocular motility deficits, while also assessing whether apparent intercenter differences persisted after covariate adjustment.
methodsA retrospective cohort was assembled from two level I trauma centers: a historical 2011 series from Inje University Sanggye Paik Hospital (n=150) and a pooled 2019-2023 series from Pusan National University Hospital (n=50). Eligibility required computed tomography-confirmed medial and/or inferior wall fracture with an intact orbital rim; patients with rim involvement or penetrating ocular trauma were excluded. Injury mechanism, fracture site, and diplopia and/or extraocular movement (EOM) limitation at presentation were abstracted from electronic medical records. Categorical comparisons used the chi-square test, and trends across calendar years were assessed using logistic regression (with year as a continuous predictor). Multivariable logistic modeling estimated adjusted odds ratios (aORs) for preoperative ocular motility deficit according to age, sex, mechanism, fracture site, calendar year, and center, with robust clustering.
resultsInterpersonal violence decreased from 34.7% of OBFs in 2011 to 14.0% in 2019-2023, representing an 11% annual decline (OR, 0.89; 95% confidence interval [CI], 0.81-0.97, P=0.007). Preoperative diplopia or EOM limitation was observed in 23 of 200 patients (11.5%): 14% in 2011 versus 4% in 2019-2023. Independent predictors of EOM limitation were interpersonal violence (aOR 3.84; 95% CI, 1.38-10.65; P=0.010) and male sex (aOR, 4.78; 95% CI, 1.49-15.49; P=0.009). Age showed a protective trend (aOR, 0.75 per decade; P=0.064); fracture extent and center were not significant after adjustment. Calendar year showed a borderline inverse association (aOR, 0.86; P=0.061), indicating a 14% annual reduction in presentation-time deficit.
conclusionsBetween 2011 and 2023, the Korean OBF landscape shifted from violent assault to accidental mechanisms, accompanied by a marked decline in preoperative ocular motility impairment. Assault mechanism and male sex remain strong risk indicators, while center-based differences appear largely explained by temporal composition. Public health efforts that reduce violence may therefore translate directly into better functional status at initial presentation.
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