Blow-out Fracture: Causes, Symptoms & Treatment

A blow-out fracture is a fracture in what is called the orbital floor. In many cases, the blow-out fracture is also called an orbital floor fracture or an overpressure fracture. A blow-out fracture is characterized by the fracture of the floor of the orbit to the maxillary sinus. In a mild blow-out fracture, the bone is merely broken. However, the orbital floor may also be affected by complete rupture in 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 impact on the corresponding area of the face. This is possible, for example, as a result of a blow with a fist or an injury caused by a tennis ball. Due to the impact of force, the orbital floor fractures. The blow-out fracture is often accompanied by defective perception. Thus, many affected persons complain of double vision and pronounced disturbances in the mobility of the eyes. In the context of a blow-out fracture, primarily the passive mobility is impaired. The reason for this is that in many cases connective and muscle tissue are trapped in the fracture gap created by the fracture. Muscle hematomas can also occur, resulting in mobility disorders. The orbit is the floor of the eye socket, which is of bony structure. When the orbital floor is fractured, the contents of the orbit sink into what is called the maxillary lumen.

Causes

A blow-out fracture usually forms from a point-blank, direct force that arrives in the area of the eyeball (medically called the bulb). The force strikes the eyeball frontally. As a result, a fracture forms in the orbital floor, and the maxillary sinus also collapses. In addition, the bulb collapses, which is why there is a risk of entrapment and injury to the soft tissues of the eyes. The force on the eyeball can also occur in the axial direction. In some cases, the blow-out fracture also occurs in combination with a fracture of the medial zygomatic arch. Likewise, a fracture at the edge of the infraorbita can occur concomitantly. This is the area below the orbit. As part of a differential diagnosis, mechanical impairments that occur as a result of a blow-out fracture must be differentiated from neurogenically caused impairments. To distinguish actual paralysis of the eye muscles from mechanically caused restrictions of eye movements, the so-called traction test is used. This tests the passive mobility of the eyes.

Symptoms, complaints, and signs

The typical symptoms that occur as part of a blow-out fracture can vary. The symptoms vary depending on the severity and extent of the fracture. For example, an increase in intraocular pressure is possible when the affected person looks in the direction of the restricted mobility. In addition, in the course of a blow-out fracture, disturbances of sensitivity in the area of the upper lip and cheeks occur in numerous cases. 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 a so-called enophthalmos. This refers to an eyeball that has sunken into the facial skull. Sometimes the gaze of the eye is restricted or even completely lost. In addition, the rectus inferior muscle is usually affected. Various injuries to the eye are also possible, such as tearing, hemorrhage, or even detachment of the retina.

Diagnosis and course

To make a definite diagnosis of a blow-out fracture, a variety of investigative methods and measures come into consideration. First, the course of the accident must be accurately documented. Subsequently, the attending physician examines the affected area for the presence of enophthalmos as well as malposition 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 asking the affected patient to describe possible visual restrictions. The person is questioned, for example, with regard to double vision. In addition, the patient’s ENT status is also checked.In addition, an X-ray examination is usually performed to look at possible bone fragments, among other things.

Complications

Various complications can occur with a blow-out fracture, depending on the severity of the symptom. In most cases, a blow-out fracture results in decreased mobility of the eye, often leading to reduced visual acuity. Sensory disturbances also often occur due to the blow-out fracture. These can occur in different regions. These include primarily 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, to avoid secondary damage. After the treatment itself, there are usually no further complications. Visual acuity may be limited in some cases, but this cannot be universally predicted. To avoid a blow-out fracture, a face shield should be worn, especially in martial arts, to prevent injury to the eye. Complications occur only if the symptom is not treated promptly.

When should you go to the doctor?

Usually, when a blow-out fracture occurs, the affected person is already directly hospitalized or treated by an emergency physician. For this reason, an additional visit to the doctor is not necessary. A doctor should be consulted if the patient suffers from severe pain in the affected areas. Limited mobility or paralysis and disturbances in sensibility may also indicate the blow-out fracture and should be examined. Normally, the eyelids can no longer be moved, which leads to significant restrictions in the patient’s daily life. Furthermore, a doctor should be consulted if there is swelling or bleeding in the affected regions. A doctor must be consulted immediately if the blow-out fracture causes visual complaints or reduced visual acuity. Treatment is provided in a hospital. The affected person may also need to see an ophthalmologist if there is visual discomfort from the blow-out fracture.

Treatment and therapy

Treatment of a blow-out fracture can be done in several ways. First, the orbital floor is usually reconstructed during a surgical procedure. Plastic or a metallic osteosynthesis material, for example, are used for this purpose. If only overpressure fractures are present, surgical therapy is not mandatory in some cases. Spontaneous improvements in the condition often occur, primarily within the first month after the accident. Therefore, any treatments and surgical interventions must be carefully weighed beforehand. Conservative therapy of the blow-out fracture may also be considered if there are no symptoms and no dislocated fracture can be detected on radiography. On the other hand, dislocated fractures usually require surgical intervention, especially if symptoms such as sensory disturbances and double vision are present.

Outlook and prognosis

The prognosis of blow-out fracture depends on the severity of the facial injury and the timing of seeking medical treatment. In many cases, and especially in the case of a mild injury, spontaneous healing may occur within a few weeks after the onset of the disease without further therapeutic measures. The symptoms suddenly disappear because the body was able to repair the existing damage on its own. In the case of a moderate to severe injury, surgical intervention is required. In this, there is a correction or stabilization of the damaged bones. The surgery is associated with the occurrence of the usual risks and side effects. If the bones can be corrected well, healing takes place within the next weeks and months. Complete freedom from symptoms is also possible.If reinforcing measures had to be taken by the use of a splint, it is checked whether this can be removed after some time or has to remain in the face for life to prevent recurrences. Some patients suffer various sequelae in blow-out fracture. These may be sensory disturbances or numbness of the skin. In most cases, they are irreparable. In addition, visual disturbances may occur. Depending on the cause of the visual disturbance, there is the possibility of the use of visual aids or there are also lifelong impairments.

Prevention

Concrete measures for the prevention of a blow-out fracture do not exist. For sports that tend to be risky, such as boxing, wearing appropriate face protection is recommended. In the event of prolonged pain as a result of a blow to the face, a physician should be consulted to provide appropriate treatment for a possible blow-out fracture.

Aftercare

In the case of a blow-out fracture, there are some aftercare options available to the individual that can speed healing and reduce further complications. In general, however, blow-out fracture always results in a positive course of disease and complete healing. In most cases, blow-out fracture is treated by surgical intervention. After such an operation, the patient should always rest and take it easy. The affected region should be immobilized and under no circumstances should any weight be placed on it. Strenuous activities and unnecessary stress should generally be avoided. This can accelerate healing. Furthermore, the patient is usually dependent on physiotherapy measures to fully restore movement. Many of the exercises from physiotherapy can also be performed at home. However, if the blow-out fracture continues to cause sensory disturbances that do not disappear on their own, a doctor must be consulted in any case to avoid further complications. Since antibiotics often have to be taken after the surgical procedure, alcohol should be avoided completely during this time. The patient’s life expectancy is not affected by the blow-out fracture.

What you can do yourself

As a rule, the affected person can accelerate the healing and recovery in the blow-out fracture with some means by himself. Patients should refrain from blowing their nose, as this increases the discomfort in most cases. Decongestant nasal drops can also alleviate the discomfort and continue to make the patient’s daily life easier. Since in many cases antibiotics must also be taken in the case of a blow-out fracture, the affected person must refrain from alcohol during this time in order not to weaken the effect of the antibiotic. Since treatment of this condition usually involves surgery, the affected person must primarily take it easy 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 discomfort can be minimized. However, if the affected person suffers from visual problems or sensory disturbances, a doctor must be consulted, as these complaints of the blow-out fracture cannot be alleviated with self-help remedies. Furthermore, a face shield should be worn during dangerous sports to prevent the recurrence of a fracture.