Techniques and Surgical Nuances of Management of Comminuted Fronto-Orbital Depressed Fractures: A Single-Surgeon Experience

Abstract Compound fronto-orbital depressed fractures (FODFs) are complex fractures involving the frontal and orbital bones, with associated lacerated wounds on the skin. Repairing such fractures is challenging and requires a multidisciplinary approach. Surgical indications include cerebrospinal fluid rhinorrhea, exposed brain matter, frontal sinus fractures, vision impairment, and cosmetic disfigurement. The repair is typically done using titanium implants (low-profile plates [LPPs] and screws) for a good functional outcome. In this case series of 10 patients operated by a single surgeon (RG), we present different techniques for repairing FODF. Early surgery (< 48 hours) was performed to minimize infection risk. Surgical steps included elevation of depressed fragments, dural repair, and reconstruction of orbital walls using LPP. Some cases required inside-out fixation or suture fixation for better alignment of fragments. Autograft was used for severe bone loss. The results showed good functional outcomes with minimal infection rates. Primary single-stage repair using titanium implants provided satisfactory cosmesis. The use of inside-out repair and sutures was beneficial in specific cases. In conclusion, primary repair of FODF with titanium implants is safe and effective, reducing morbidity and cost. Early surgery and proper techniques are crucial for successful outcomes. Longer follow-up is needed to assess long-term viability and bone resorption.