Reconstruction of Orbital Medial Wall Fracture with Absorbable and Non-Absorbable Orbital Implant: Comparative Study

Min Kyung Kim; Sun Young Jang; Hye Sun Choi

doi:10.3341/jkos.2014.55.5.640

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Kim, Jang, and Choi: Reconstruction of Orbital Medial Wall Fracture with Absorbable and Non-Absorbable Orbital Implant: Comparative Study

Original Article

J Korean Ophthalmol Soc 201;55(5):640-645.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.5.640

Reconstruction of Orbital Medial Wall Fracture with Absorbable and Non-Absorbable Orbital Implant: Comparative Study

Min Kyung Kim, MD¹, Sun Young Jang, MD², Hye Sun Choi, MD^1,

¹Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Myung-Gok Eye Research Institute, Seoul, Korea

²Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Address reprint requests to Hye Sun Choi, MD, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Myung-Gok Eye Research Institute, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 150-034, Korea, Tel: 82-2-2639-7811, Fax: 82-2-2633-3976 E-mail: hs0903@kimeye.com

Received 28 September 2013 Revised 4 December 2013 Accepted 18 April 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the surgical results and complications of medial wall fracture reconstruction using non-absorbable porous polyethylene implants (Medpor®, Stryker Instruments, Kalamazoo, Michigan, USA) and an absorbable polymer of polyglycolic acid (PGA) and polylactic acid (PLA) (Mesh plate®, Inion Ltd, Tampere, Finland).

Methods

We retrospectively reviewed the data of patients who underwent reconstruction of medial wall fracture between January 2007 and June 2012 and divided them into 2 groups according to orbital implant type (Medpor®, Mesh plate®).

Results

Among the 86 patients, 37 were treated with Medpor® and 49 with Mesh plate®. There was no statistically significant difference in limitation of motion or diplopia score between the 2 groups at postoperative 6 months (Fisher's exact test, p = 0.192, p = 0.128, respectively). Mean postoperative exophthalmometry differences between the eyes were 0.49 ± 1.04 mm and 0.37 ± 0.62 mm in Medpor® and Mesh plate® groups, respectively, showing no statistically significant difference (independent f-test, p = 0.512). Postoperative complications such as inflammation or implant malposition were observed only in 3 patients in the Medpor® group.

Conclusions

No difference was observed between Medpor® and Mesh plate® in terms of surgical results during the postoperative 6 month period after reconstruction of orbital medial wall fracture. However, postoperative complications were observed in 3 patients in the Medpor^® group.

Keywords: Implants, Medial wall fracture, Medpor, Mesh plate, Orbital wall reconstruction

References

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Figure 1.

Pre and post-treatment external photographs (A, B, D) and CT scans (C, E) of the patient who developed inflammation around the plate after reconstruction of a medial wall fracture with Medpor®. A 65-year-old patient presented with erythematous swelling of the left upper and lower eyelids 2 years after open reduction of medial wall fracture with Medpor® (A, B). CT scan shows marked proptosis of left eye and increased dirty densities along the surgical plate (C). The patient received systemic steroid treatment and eyelid swelling improved (D). CT scan shows decreased densities along the surgical plate, suggesting improvement of inflammation (E).

Figure 2.

CT scan of the patient who complained of epiphora and palpable plate, suggesting malposition of surgical plate after reconstruction of a medial wall fracture with Medpor®. A 55-year-old patient presented with epiphora of the right eye 1 month after open reduction of a medial wall fracture with Medpor®. CT scan showed lacrimal sac compression by surgical plate, and ocular symptoms were improved after surgical plate removal.

Table 1.

Demographic data and cause of fracture of patients who undergone reconstruction of medial wall fracture using Medpor® or Mesh plate®

	Medpor® (%)	Mesh plate® (%)	p-value
N	37	49
Sex (M:F)	28:9	42:7	0.236^*
Time of repair from trauma (days)	13.90 ± 9.76	12.53 ± 7.16	0.402^†
Cause of fracture			0.112^‡
Violence	16	20
Fall down	12	8
Sports	3	11
Traffic accident	0	3
Others	6	7

Values are presented as mean ± SD.

^* p-value by Chi-square test;

^† p-value by Independent t-test;

^‡ p-value by Fisher's exact test.

Table 2.

The surgical indications of patients who undergone reconstruction of medial wall fracture using Medpor® or Mesh plate®

	Medpor® (%)	Mesh plate® (%)	p-value
Enophthalmos	16 (43.2)	19 (38.8)	0.703^*
Large fracture ^†	11 (29.7)	16 (32.7)
Diplopia / LOM	8 (21.6)	8 (16.3)
Muscle or soft tissue incarceration	2 (5.4)	6 (12.2)

LOM= limitation of motion.

^* p-value by Fisher's exact test;

^† The percent of the bony defect to the involved orbital wall on coronal CT scans, in which largest bony defect was observed, was larger than 50%.

Table 3.

The degree of diplopia and limitation of motion of patients at postoperative 6 months

	Medpor® (%)	Mesh plate® (%)	p-value
Limitation of motion			0.192^*
0	31 (83.8)	46 (93.9)
-1	5 (13.5)	3 (6.1)
-2	1 (2.7)	0 (0)
-3	0 (0)	0 (0)
-4	0 (0)	0 (0)
Diplopia			0.128^*
Grade 0	27 (73.0)	42 (85.7)
Grade I	10 (27.0)	6 (12.2)
Grade II	0 (0)	1 (2.0)
Grade III	0(0)	0 (0)

^* p-value by Fisher's exact test.

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