M Wevers, E M Strabbing, M A J Telleman, E B Wolvius
Orbital trapdoor fractures, traditionally considered a pediatric injury, also occur in adults and may present with distinct clinical presentation and management. This cohort study compares adult and pediatric patients with orbital trapdoor fractures and evaluates clinical presentation, radiological findings, operative management, and long-term clinical and orthoptic outcomes, as well as the influence of surgical timing by comparing early (within 2 days) versus late (after 2 days) intervention. Nineteen patients (12 children and seven adults) with clinically and computed tomography-confirmed trapdoor fractures who were surgically treated at the Erasmus Medical Center between 2012 and 2024 and had at least 3 months of follow-up were analyzed retrospectively. The primary outcomes were diplopia and limitation of ocular motility assessed 1 year postoperatively. Secondary outcomes included presenting symptoms, radiological findings, and operative characteristics. Clinical profiles and radiological findings were largely similar between adults and children, including presence of rectus muscle incarceration. Three months after surgery, diplopia was present in 55% of children and 57% of adults. One year postoperatively, one out of 10 children and three out of four adults still reported diplopia, attributable to mild elevation or depression deficits. Lasting impairment in activities of daily living was uncommon. All patients with persistent diplopia or motility limitation underwent surgery more than 2 days after trauma. Early surgical intervention appears to be associated with more favorable long-term ocular motility outcomes.