Timing of surgery for orbital burst fractures

  Surgical intervention for a burst orbital fracture is considered early if it is performed during the acute phase of the trauma, generally measured within 14 days. Although no surgical intervention for orbital burst fractures within one month of trauma decreases the chances of success, the acute phase of trauma is the best time for fracture orbital wall remodeling and recovery of ocular motility. Surgical intervention for orbital burst fractures is considered delayed if performed 3 weeks to 4 months after the trauma. In the delayed intervention period, the fused fracture fragment can still move without osteotomy and the prolapsed soft tissue can be separated from the fracture area.  If surgical intervention for orbital burst fractures is performed after 4 months of trauma, osteotomy is often required to separate the orbital soft tissues and reset the fracture zone. Moreover, 4 months after trauma, cosmetic and functional improvement is not desirable due to scarring of the embedded soft tissues in the fracture zone!