Dunphy Louise, Anand Pradeep
Department of Surgery, Milton Keynes University Hospital, Milton Keynes, UK.
Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford, UK.
BMJ Case Rep. 2019 Apr 3;12(4):e228739. doi: 10.1136/bcr-2018-228739.
Trapdoor fractures, otherwise known as 'white-eyed blowout' fractures, occur predominantly in the paediatric cohort and have a male predilection. Patients commonly present with acute fractures to the emergency department, and delayed diagnosis can result in significant morbidity. A lack of external signs, such as oedema or ecchymosis, often misleads physicians into underestimating the seriousness of the injury. It can be initially misdiagnosed as a head injury due to the oculocardiac reflex, nausea, vomiting, poor patient compliance and a failure to examine the eye appropriately. The incarcerated muscles may become necrotic because of ischaemia, resulting in ocular motility problems. Immediate surgery is recommended for symptomatic persistent diplopia or clinical evidence of muscle entrapment. The authors present the case of a 16-year-old male adolescent initially diagnosed with a head injury due to his nausea and vomiting following trauma to his orbit. This resulted in a delay to surgery. This article highlights the importance of performing an ophthalmic assessment to detect other features of a trapdoor fracture in children presenting with orbital trauma. It also reinforces the importance of knowledge of the oculocardiac reflex as its association with orbital injuries is well documented.
隐匿性骨折，又称“白眼爆裂”骨折，主要发生在儿童群体中，男性更为多见。患者通常因急性骨折前往急诊科就诊，延迟诊断可能导致严重的并发症。缺乏如水肿或瘀斑等外部体征，常常使医生低估损伤的严重性。由于眼心反射、恶心、呕吐、患者配合度差以及未对眼睛进行适当检查，最初可能会误诊为头部损伤。嵌顿的肌肉可能因缺血而坏死，导致眼球运动问题。对于有症状的持续性复视或肌肉嵌顿的临床证据，建议立即进行手术。作者介绍了一名16岁男性青少年的病例，该患者最初因眼眶外伤后出现恶心和呕吐被诊断为头部损伤，这导致了手术延迟。本文强调了对眼眶外伤儿童进行眼科评估以发现隐匿性骨折其他特征的重要性。它还强化了了解眼心反射的重要性，因为其与眼眶损伤的关联已有充分记录。
