Orbital Fractures at a Level 1 Trauma Center: A Retrospective Epidemiological Analysis of 1489 Consecutive Fracture Records

Objectives: Comprehensive epidemiological data on orbital fractures from large full-spectrum series remain scarce. We describe the demographics, mechanisms, fracture anatomy, CT-derived defect morphometry, and clinical findings at presentation of orbital fractures managed at a level 1 trauma center. Methods: We retrospectively analyzed 1489 consecutive CT-confirmed orbital fracture records managed at Rambam Health Care Campus, Haifa, Israel, between September 2001 and November 2023. Demographics, mechanism, fracture location, laterality, CT-derived defect dimensions, orbital content herniation, inferior rectus muscle (IRM) involvement on CT, diplopia, concomitant facial fractures, and timing of repair were analyzed. The analysis was planned as descriptive; a single pre-specified comparison (age between sexes) was tested, and no inferential modelling of treatment decisions or outcomes was undertaken. Results: The cohort was 78.6% male (M:F 3.7:1), with a mean age of 36.5 ± 20.0 years; patients aged 18–29 years predominated (33.5%). Females were older than males (46.3 ± 24.6 vs. 33.9 ± 17.7 years; p < 0.001). Falls (33.0%) and assault (26.1%) were the principal mechanisms. The orbital floor was involved in 87.7% of fractures (isolated in 58.6%); mean sagittal and coronal defect diameters were 13.7 ± 6.1 and 13.3 ± 5.1 mm. Content herniation was present in 55.1%, IRM involvement on CT in 14.7%, and diplopia in 17.6%; concomitant facial fractures occurred in 27.9%, and 72.9% underwent repair, at a median of 2 days. Conclusions: In one of the largest single-center orbital fracture cohorts reported, a young-adult male, floor-dominant profile predominated. Herniation, radiological muscle involvement, diplopia, and associated facial fractures were common, indicating the functional and diagnostic complexity of this injury pattern. These descriptive findings characterize the population presenting to a level 1 center; they do not evaluate management strategies and should not be read as establishing surgical indications, thresholds, or optimal timing.