A 45-year-old male involved in a road traffic accident presents with telecanthus, a depressed nasal bridge, and mobility of the medial canthal tendon attached to a central bony fragment. CT shows comminution of the nasal bones and medial orbital walls. This pattern corresponds to which type of naso-orbito-ethmoid (NOE) fracture classification?

• A Type II: comminuted central fragment with medial canthal tendon attached ✓
• B Type I: single-segment central fragment with medial canthal tendon still attached
• C Type III: comminuted fracture with avulsion of the medial canthal tendon
• D Type IV: isolated avulsion of the medial canthal tendon without bony involvement

Explanation

Markowitz classification of NOE fractures defines Type II as a comminuted central fragment where the medial canthal tendon remains attached to a fragment of bone. Type I has a single non-comminuted segment. Type III involves tendon avulsion from the fragment. The presence of a mobile medial canthal tendon attached to bone distinguishes Type I from Type II, and the comminution here makes this Type II.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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Written and medically reviewed by the StethoPrep medical team.