Clinical Evaluation and Pitfalls of Orbital Floor Reconstruction Using Super FIXSORB: A Single-Center Retrospective Observational Case Series of 20 Patients

Orbital floor fractures impair ocular function and often need surgical repair. Super FIXSORB, a bioresorbable u-HA/PLLA composite, offers osteoconductivity and strength. However, few studies have quantitatively assessed functional recovery after reconstruction with this material. This study aimed to evaluate the clinical course and key pitfalls following orbital floor reconstruction using Super FIXSORB, focusing on motility recovery, bone remodeling, and diplopia. We retrospectively reviewed 20 patients with isolated orbital floor fractures who underwent reconstruction with Super FIXSORB at one center. Extraocular motility was assessed using HESS chart analysis; globe position was evaluated via computed tomography (CT). In 15 cases, the location of bone fragments relative to the plate was measured using coronal CT. Subjective diplopia was graded with a standardized system. The mean 30-degree HESS score improved from 0.765±0.18 to 0.949±0.09. Sixteen patients achieved HESS >0.85 within 2 months postoperatively, and none worsened. In 15 cases with measurable gaps between bone and implant, the median fragment-to-plate distance (FPD) decreased from 5.40 mm (IQR 3.28-7.58) to 1.21 mm (0.76-1.89) (P=0.000061), indicating progressive remodeling toward the plate. Globe position on CT stayed within ±2 mm in all patients. No infections or implant-related issues were noted. Super FIXSORB reconstruction led to early, lasting improvements in motility and structural stability. CT analysis showed gradual bone migration toward the plate, consistent with osteoconduction. Still, clinicians should note that favorable HESS scores may not fully predict diplopia resolution, especially with muscle entrapment.