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Fractures About the Orbit in Professional American Football Players

Riley J. Williams, III, MD, Robert G. Marx, MD, MSc, Ronnie Barnes, ATC, Stephen J. O’Brien, MD and Russell F. Warren, MD

Sports Medicine and Shoulder Service, Hospital for Special Surgery—Cornell University Medical College, New York, New York

Presented at the 26th meeting of the AOSSM, Traverse City, Michigan, June 1999.

Address correspondence and reprint requests to Riley J. Williams III, MD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

A retrospective review was performed of records for players who suffered fractures about the orbit during participation in officially sponsored activities of the National Football League from 1980 to 1997. Clinical information was obtained on 19 of 29 players who sustained orbital fractures. The most common signs and symptoms included decreased visual acuity (74%, 14), decreased eye movement (42%, 8), hyphema (37%, 7), and infraorbital numbness (21%, 4). The mechanisms of injury were a digital poke (74%, 14) and blunt facial trauma (26%, 5). There were significantly more orbital fractures than zygomatic fractures suffered by offensive linemen as compared with all other positions. Fifteen of 19 players were managed with surgical reconstruction; 4 players were treated nonoperatively. The mean time from injury to surgical procedure was 7.7 days (range, 0 to 42). The mean interval to follow-up was 45.6 months (range, 3 to 146). At follow-up examination, eight (53%) of the patients treated surgically still reported diplopia with upper field gaze. Three of the four patients treated nonoperatively were asymptomatic. The mean time lost from games or practice was 25 days (range, 5 to 56). Ultimately, 17 (89%) players with orbital fractures were able to return to full football activities. Two patients were unable to resume their careers because of residual visual impairment.

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