Karsteter Page A, Yunker Craig
US Military-Baylor University Post-Professional Sports Medicine-Physical Therapy Doctoral Program, West Point, NY, USA.
J Orthop Sports Phys Ther. 2006 Aug;36(8):611-8. doi: 10.2519/jospt.2006.2207.
Case report.
To identify key elements in the recognition and management of a patient with an orbital blowout fracture and make recommendations on diagnosis, treatment, referral, imaging, and return to sports.
Orbital blowout fractures are uncommon but important injuries for physical therapists to recognize. Immediate management is essential in preventing complications. The mechanism of injury is a direct blow to the orbital rim or orbit.
The patient reported to the athletic training room 15 minutes after completing a boxing match and reported that his left eye had suddenly inflated after blowing his nose. We suspected an orbital blowout fracture and referred him immediately to the emergency department where conventional radiographs were ordered. On follow-up the next day, after determining that the radiographs were normal, but still having a high index of suspicion for an orbital blowout fracture, we referred him to his primary care manager. The primary care manager ordered a computed tomography scan that revealed the fracture and referred the patient to ophthalmology.
The patient was restricted from the remaining 4 weeks of the boxing season. He completed a rigorous Army physical fitness test 7 days postinjury and the Marine Corps Marathon 47 days postinjury.
Orbital blowout fractures without double vision, extraocular muscle entrapment, or persistent numbness can be treated with time and protection. The patient can continue with normal fitness activities except contact or collision sports.
病例报告。
确定眼眶爆裂性骨折患者识别与管理的关键要素，并就诊断、治疗、转诊、影像学检查及恢复运动提出建议。
眼眶爆裂性骨折虽不常见，但对物理治疗师而言是需识别的重要损伤。立即处理对于预防并发症至关重要。损伤机制为眼眶边缘或眼眶受到直接打击。
患者在完成一场拳击比赛15分钟后前往运动训练室，称在擤鼻后左眼突然肿胀。我们怀疑眼眶爆裂性骨折，立即将他转诊至急诊科，并安排了常规X光检查。次日随访时，在确定X光检查结果正常，但对眼眶爆裂性骨折仍高度怀疑后，我们将他转诊给其初级保健医生。初级保健医生安排了计算机断层扫描，结果显示骨折，并将患者转诊至眼科。
患者在拳击赛季剩余的4周内被限制参赛。他在受伤7天后完成了严格的陆军体能测试，并在受伤47天后完成了海军陆战队马拉松赛。
无复视、眼外肌嵌顿或持续性麻木的眼眶爆裂性骨折可通过时间和保护措施进行治疗。患者可继续进行正常的健身活动，但应避免接触性或碰撞性运动。
