The “Rocky” Factor: Minimizing Globe Injury in Subsequent Orbital Floor Fractures in Repeat Offenders

Background: Recurrent or repeat orbital floor and/or medial wall fractures may have an increased risk of globe injury and vision loss. To see if the initial orbital floor repair technique and/or chosen material for reconstruction impact the result, we studied repeat offenders who engage in: (1) repeat assaults, (2) unprotected sports injuries, or (3) seizure disorders. Methods: From 715 patients who underwent traumatic orbital floor repair over an 18-year period, 58 “repeat offenders” suffered a subsequent orbital fracture and were studied. Type of repair and outcomes including globe injuries were documented. Results: Repeat offenders who had a second orbital fracture had initial repairs with: resorbable plates (63.8%), titanium mesh (12.1%), and split cranial bone grafts (14%). More significant globe injuries occurred when initial repair was with titanium plates (86%) and bone grafts (14%) compared to resorbable plates (0%). Of the total group with initial orbital fractures and repair, 15% were categorized as “at risk” to be repeat offenders based on their medical history and activity. Of the “repeat offenders” who had an additional orbital fracture, 95% (50/58) fell into the “at risk” category for “repeat offending.” Conclusion: Resorbable plate orbital floor and/or medial wall fracture repair may offer less significant globe injury for repeat offenders at risk for subsequent orbital trauma.