Abbreviated as OBF by Abbreviationfinder, a blow-out fracture is a break in what is known as the orbital floor. In many cases, the blow-out fracture is also referred to as an orbital floor fracture or a positive pressure fracture. A blow-out fracture is characterized by breaking the floor of the eye socket down to the maxillary sinus. In the case of a slightly pronounced fracture, the bone is only cracked. However, the orbital floor can also be affected by a complete breakthrough as part of a blow-out fracture.
What is a blow-out fracture?
In the majority of cases, a blow-out fracture occurs as a result of a blunt force applied to the corresponding area of the face. This can be done, for example, by punching a fist or injuring yourself with a tennis ball. Due to the force applied, the floor of the orbit breaks. The blow-out fracture is often associated with incorrect perception.
Many affected people complain of double vision and pronounced disturbances in the mobility of the eyes. Passive mobility is primarily impaired in the context of a blow-out fracture. The reason for this is that connective and muscle tissue are in many cases trapped in the fracture gap created by the fracture.
Also, muscle hematomas occur, have the mobility disorders result. The orbit is the floor of the eye socket, which has a bony structure. If the floor of the eye socket breaks, the content of the orbit sinks into the so-called maxillary sinus lumen.
Causes
A blow-out fracture usually forms as a result of punctual and direct force that hits the area of the eyeball (medical term for the globe). The force hits the eyeball head-on. As a result, a fracture forms in the orbital floor, which also causes the maxillary sinus to collapse.
In addition, the globe sinks in, which is why there is a risk that the soft tissues of the eyes will be pinched and injured. The force applied to the eyeball can also take place in the axial direction. In some cases, the blow-out fracture also occurs in combination with a rupture of the medial zygomatic arch.
A fracture at the edge of the infraorbita can also occur. This is the area below the eye socket. As part of a differential diagnosis, mechanical limitations that occur as a result of a blow-out fracture must be distinguished from neurogenic impairments.
The traction test mentioned is used to distinguish actual paralysis of the eye muscles from mechanically caused restrictions in eye movements. This tests the passive mobility of the eyes.
Symptoms, ailments & signs
The typical symptoms that occur as part of a blow-out fracture can vary. The symptoms vary depending on the severity and severity of the fracture. An increase in intraocular pressure is possible if the person concerned looks in the direction of the restricted mobility.
In addition, in numerous cases of a blow-out fracture, sensitivity disorders in the area of the upper lip and cheeks occur. In addition, so-called monocular hematomas sometimes form. This is a special form of hematoma that affects both the upper and lower eyelids.
Another possible symptom of a blow-out fracture is what is known as an enophthalmos. This refers to an eyeball that has sunk into the skull. Sometimes the turning of the eye is restricted or even completely eliminated. In addition, the inferior rectus muscle is usually affected. Various injuries to the eye are also possible, such as tears, bleeding or detachment of the retina.
Diagnosis & course
In order to make a reliable diagnosis of a blow-out fracture, a large number of examination-technical methods and measures can be considered. First of all, the course of the accident must be precisely documented. The attending physician then examines the affected area for the presence of enophthalmos and a misalignment of the eyeballs.
A possible step formation in the face, caused by the fracture, is also inspected. Finally, the mobility of the eyeball is tested by requiring the patient to describe possible visual impairments. For example, the person is asked about double vision.
In addition, the patient’s ENT status is checked. In addition, an X-ray examination is usually carried out, during which, among other things, possible bone fragments are seen.
Complications
With a blow-out fracture, different complications can arise, depending on the severity of the symptom. In most cases, a blow-out fracture leads to reduced mobility of the eye and thus often to impaired vision. The blow-out fracture also often leads to sensory disorders. These can occur in different regions.
Above all, this includes the lips and cheeks. However, the nose and cheeks can also be affected by these disorders. In the worst case, the eye can no longer be moved due to the blow-out fracture. In addition, there is possible damage that occurs to the eye itself. This includes bleeding, tearing, or damage to the retina itself.
In most cases, a blow-out fracture can be treated relatively well, but surgery is usually necessary to repair the damage. A doctor should be consulted, especially after an accident, in order to avoid consequential damage. After the treatment itself, there are usually no further complications.
The eyesight can be limited in some cases, but this cannot be universally predicted. To avoid a blow-out fracture, face protection should be worn, especially in martial arts, to avoid injuries to the eye. Complications only arise if the symptom is not treated promptly.
When should you go to the doctor?
As a rule, if someone has a blow-out fracture, they are taken straight to a hospital or treated by an emergency doctor. For this reason, an additional visit to the doctor is not necessary. A doctor should then be consulted if the patient has severe pain in the affected areas. Restricted mobility or paralysis and sensitivity disorders can also indicate the blow-out fracture and should be investigated.
Normally the eyelids can no longer be moved, which leads to significant restrictions in the patient’s everyday life. Furthermore, a doctor should be consulted if there is swelling or bleeding in the affected areas. A doctor should be seen immediately if the blow-out fracture causes visual problems or decreased eyesight. The treatment takes place in a hospital. The person concerned may also need to see an ophthalmologist if there are visual problems due to the blow-out fracture.
Treatment & Therapy
There are several ways to treat a blow-out fracture. First of all, the orbital floor is usually reconstructed as part of a surgical procedure. For example, plastic or a metallic osteosynthesis material are used for this purpose. If only positive pressure fractures are present, surgical therapy is not absolutely necessary in some cases.
Often times, there are spontaneous improvements in condition, primarily occurring within the first month after the accident. Therefore, any treatments and surgical interventions must be carefully considered beforehand. Conservative treatment of the blow-out fracture is also possible if there are no symptoms and no displaced fracture can be detected on the X-ray examination.
Displaced fractures, on the other hand, usually require surgical intervention, especially if there are symptoms such as impaired sensation and double vision.
Outlook & forecast
The prognosis for a blow-out fracture depends on the severity of the facial injury and when to seek medical treatment. In many cases, and especially with a minor injury, spontaneous healing can occur within a few weeks of the onset of the disease without further therapeutic measures. The symptoms suddenly disappear as the body was able to repair the existing damage on its own.
Surgical intervention is required for a moderate to severe injury. In this, the damaged bones are corrected or stabilized. The operation is associated with the occurrence of the usual risks and side effects. If the bones can be corrected well, they will heal within the next few weeks and months.
Complete freedom from symptoms is also possible. If reinforcing measures had to be taken through the use of a splint, it is checked whether it can be removed again after a while or whether it must remain on the face for life to avoid relapses.
Some patients experience various sequelae from the blow-out fracture. These can be sensory disturbances or a feeling of numbness on the skin. In most cases, they are irreparable. In addition, there may be visual disturbances. Depending on the cause of the visual impairment, there is the possibility of using visual aids or life-long impairments.
Prevention
There are no concrete measures to prevent a blow-out fracture. For sports that tend to be risky, such as boxing, it is advisable to wear appropriate face protection. In the event of persistent pain as a result of a blow to the face, a doctor should be consulted in order to treat a possible blow-out fracture appropriately.
Aftercare
In the case of a blow-out fracture, there are a number of follow-up options available to those affected, which can accelerate healing and reduce further complications. As a rule, however, the blow-out fracture always results in a positive course of the disease and complete healing. In most cases, the blow-out fracture is treated with surgery.
After such an operation, the patient should always rest and take it easy. The affected region must be kept calm and must not be stressed under any circumstances, strenuous activities and unnecessary stress should generally be avoided. This can accelerate healing.
Furthermore, the patient is mostly dependent on physical therapy measures to fully restore movement. Many of the exercises from physiotherapy can also be performed in your own home. However, if the blow-out fracture continues to cause sensitivity disorders that do not go away on their own, a doctor must be consulted in order to avoid further complications.
Since antibiotics often have to be taken after the surgical procedure, alcohol should be completely avoided during this time. The life expectancy of the patient is not affected by the blow-out fracture.
You can do that yourself
Usually, some means can help the person hasten the healing and recovery of the blow-out fracture. Patients should refrain from blowing their nose, as this will worsen the symptoms in most cases. Decongestant nasal drops can also alleviate the symptoms and make everyday life easier for the patient.
Since antibiotics also have to be taken in many cases of a blow-out fracture, the person affected must refrain from alcohol during this time in order not to weaken the effect of the antibiotic. Since the treatment of this disease usually takes place through a surgical procedure, the affected person must above all rest and rest afterwards. Bed rest and relaxation also have a very positive effect on the course of this complaint. With the help of soothing and decongestant creams, the symptoms can be minimized.
However, if the person concerned suffers from visual problems or from sensitivity disorders, a doctor must be consulted, as these symptoms of the blow-out fracture cannot be alleviated by means of self-help. In addition, face protection should be worn during dangerous sports in order to avoid the recurrence of a fracture.
