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Medical Forum / General / Vision / November 2006

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Tripod Fracture

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duanestorey@gmail.com - 20 Nov 2006 07:39 GMT
Hey everyone,

About two weeks ago, some guy kicked me in the head while I was on the
ground.  I was in the hospital that night, and was diagnosed with a
minimally displaced tripod fracture.  I met with a plastic surgeon a
week later, and he said that because the fracture wasn't really
displaced that much (on the order of 1mm), he said it was probably best
to just leave it, since surgery might not be able to repair such a
small defect properly (which sounded ok to me).  However, at the time I
had double vision while looking up, although both of my eyes seemed
close to the same position horizontally.

It's been a week since the plastic surgury meeting (so about two weeks
since the injury), and I still have double vision looking upwards.
Also, my injured eye appears slightly lower in my face then my other
eye.  This seems characteristic of a blowout fracture (although neither
the ER doctor or the plastic surgeon mentioned this).  They did however
mention that my sinus had blood in it (which also seems to be a symptom
of a blowout fracture.

Originally he said to only come back if the double vision didn't
resolve within 6 weeks or so. However, reading online it seems like if
surgery is needed, it should be performed within about two weeks of the
original injury, otherwise scarring can occur and limit the results
with surgery.

I'm supposed to be heading to Mexico on Friday, so I'm not really sure
what to do. Should I go and try to schedule an appointment when I get
back.  Or should I be persistant and try to get another meeting before
I go?  Any comments on the injury?

Thanks,
Duane
David Robins, MD - 21 Nov 2006 06:15 GMT
I would see an ophthalmologist pronto. You need to rule-out inferior rectus
and fat entrapment. By 1 week, swelling would go down enough to be able to
determine this. And, yes, 2 weeks is the optimum limit on starting to repair
these, as once siginificant scarring occurs, it is a bear to try to fix it.
From your description, this may be a blowout fracture, but could be a tripod
fx with associated floor fracture causing an entrapment, without it being a
real "blowout" fracture. The plastics specialist who recommended waiting
ANOTHER 6 weeks is outside of the norm, I think.

The general ophthalmologist should be able to determine this. If unsure, you
need to see an orbital specialist, an oculo-plastics ophthalmologist. While
these are repaired by the specialties of plastic surgery, head and neck
surgery , and oculoplastics, the one which seem to be able to pay more
attention to the double vision problems, rather than just appearance, is the
oculoplastics.

If the repair is done correctly, some double vision may remain anyway. This
is occasionally treatable with prism glasses by optometry or ophthalmology.
Worse cases require eye muscle surgery, usually by a strabismus specialist
(also called pediatric ophthalmology and adult strabismus specialty,
commonly).


David Robins, MD
Board certified Ophthalmologist
Pediatric ophthalmology and adult strabismus subspecialty

On 11/19/06 11:39 PM, in article
1164008358.875479.145100@h54g2000cwb.googlegroups.com,

> Hey everyone,
>
[quoted text clipped - 29 lines]
> Thanks,
> Duane
duanestorey@gmail.com - 26 Nov 2006 08:55 GMT
Thanks for the email.  I did get a second opinion, and it was
determined I did have a floor fracture.   I was scheduled for surgery
two days later, and have since had it repaired.

I think the results are quite good so far (in terms of my eye position
and double vision), but they chose not to do the transconjunctival or
subcilary approach for some reason, and instead incised directly along
the orbital rim line along my cheek.  Hopefully this doesn't scar too
much.

Duane

> I would see an ophthalmologist pronto. You need to rule-out inferior rectus
> and fat entrapment. By 1 week, swelling would go down enough to be able to
[quoted text clipped - 58 lines]
> > Thanks,
> > Duane

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