Emerg Med J 20:66 doi:10.1136/emj.20.1.66-a
  • Best evidence topic reports

Antibiotics in orbital floor fractures

  1. Bruce Martin, Specialist Registrar,
  2. Angaj Ghosh, Senior Clinical Fellow,
  3. K Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}


      A short cut review was carried out to establish whether prophylactic antibiotics are indicated in patients with undisplaced maxillary or orbital floor fractures. Altogether 214 papers were found using the reported search, but none presented any evidence to answer the clinical question. More research is needed in this area and, in the mean time, local advice should be followed.

      Report by Bruce Martin, Specialist Registrar
 Checked by Angaj Ghosh, Senior Clinical Fellow

      Clinical scenario

      A 28 year old man presents to the emergency department with a punch injury to the left side of his face after a fracas. Clinical examination reveals no wound, but tenderness, bruising and swelling over the left infraorbital area. Radiological examination confirms the presence of fluid within the maxillary sinus, suggesting an undisplaced fracture of the orbital floor. You wonder whether you should prescribe him oral antibiotics to reduce the incidence of infection.

      Three part question

      In [patients with undisplaced maxillary or orbital floor fractures] are [antibiotics better than no antibiotics] at [preventing infective complications]?

      Search strategy

      Medline 1966–10/02 using the OVID interface. [(exp facial bones OR exp facial injuries OR AND (exp fractures OR exp maxillary fractures OR exp orbital fractures OR exp zygomatic fractures OR fracture$.mp) AND (exp antibiotics OR antibiotic$.mp)] LIMIT to human AND English.

      Search outcome

      Altogether 214 papers were found of which all were of irrelevant or of insufficient quality.


      The evidence in this field is clearly lacking. There are no trials of any kind looking at the incidence of infection in patients with undisplaced orbital floor fractures. There is clearly a need for further investigation into this area.


      Local advice should be followed.

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      Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


      0.5% - 43% response rate
      3% - 41% response rate
      10% - 16% response rate

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