Assessment Of Forensic And Clinical Criteria Of Orbital Blowout Fractures For Use In Bioarchaeological Analysis

Orbital blowout fractures are a particular facial fracture occurring within the inner eye orbits of the face caused by blunt force trauma to the eyeball or the lower orbital rim. This fracture is common in modern clinical contexts due to physical assaults, but examining this fracture in skeletal material can also provide insights into the patterns of interpersonal violence within the fields of bioarchaeology and forensic anthropology. Issues with analyzing this fracture in skeletal material arise due to the clinical assessment practices of blowout fractures, where medical practitioners are highly focused on the soft tissue presentations of the fracture in a patient. In this study, standard clinical criteria for defining an orbital blowout fracture were analyzed and translated into criteria that could be used to assess skeletal material where no soft tissue is present. A set of scoring criteria was developed to analyze skeletal material based on four traits commonly observed in this fracture pattern, and the material was examined for any post-mortem taphonomy that could be mistaken for perimortem trauma. In this study, thirteen individuals were selected from online osteological databases and examined to score the possible presence of orbital blowout fractures. The scoring results of this study were further tested using positive and negative likelihood ratio tests (LRT) and indicated that eight individuals were highly likely to have blowout fractures present. The presence of nasal fractures was noted in 69.2% of individuals utilized in this study and presents a possible correlation with blowout fractures that should be further explored. The scoring sheet developed in this study establishes a standardized methodology for reporting orbital blowout fractures in contexts lacking soft tissue, providing a valuable tool for the consistent analysis of orbital trauma in bioarchaeology.