Computed Tomography Evaluation of Orbital Wall Fractures among Head Injury Patients Following Vehicular Accidents in Anambra State, Nigeria: A Retrospective Review

Abstract

Background: Orbital trauma is a common cause of monocular blindness and impairment of vision, usually resulting from significant blunt force to the bony eye socket as may occur during vehicular accidents. Computed tomography is the ideal imaging modality for the assessment of traumatic head injury including orbital fractures. Objective: To document the prevalence and pattern of orbital wall fractures as seen on CT among adult victims of passenger vehicular accidents at two health institutions in Anambra State, with documentation of possible co-existing craniofacial fractures and intracranial haemorrhage and establish associations if any. Methodology: Cranial CT images for Sixty-three adult patients diagnosed with orbital fractures following vehicular accidents at two hospitals in Anambra State (Nnamdi Azikiwe University Teaching Hospital, Nnewi and Iyienu Mission Hospital, Ogidi) between 1st January, 2014 and 31st December, 2015 were reviewed.
Results: Study population comprised 36.4% of all cases of craniofacial fractures imaged during study period. 52 males (82.5%) and 11 females (17.5%) were affected, with mean age of 33.4years. Orbital wall fractures were lateral (60.3%), medial (49.2%), orbital roof (36.5%) and orbital floor (3.2%). Lateral orbital wall fractures show statistically significant association with ipsilateral zygomatic fractures (p-value = 0.00). Also, orbital roof and lateral orbital wall fractures show an association with acute subdural (p-value = 0.02) and epidural bleeds respectively (p-value = 0.04). Conclusion: Orbital fractures constitute a fairly high proportion of craniofacial fractures following vehicular accidents in Anambra State affecting mainly the productive age group. Also, a large proportion of patients with orbital fractures have co-existing intracranial complications with likely worsened morbidity.

Keywords: Imaging in head injury, Orbital injuries, Cranial CT, Monocular blindness, Vehicular Accidents.