Trapdoor fracture

Case contributed by Dr Sean McIlhone

Presentation

Clashed heads with another player during rugby training. Immediately developed left orbital pain and unable to perform upward gaze with left eye.

Patient Data

Age: 13
Gender: Male
CT

CT images demonstrate a minimally displaced fracture, running in the sagittal plane, through the floor of the left orbit, just medial to the infra-orbital canal. The inferior rectus muscle is entrapped within the defect. There is an associated angulation seen within the inferior rectus on the sagittal images.

Appearances are consistent with a trapdoor-type blowout fracture of the left orbital floor, with entrapment of the left inferior rectus muscle.

Case Discussion

The patient went for surgical exploration the same day, which confirmed the above findings. The inferior rectus muscle was released and the orbital floor defect repaired.

Due to the relative elasticity of the orbital floor in patients of this age group, blowout fractures in this area have a tendency to recoil back to their original position, like a trapdoor. This can result in entrapment of orbital contents, as in this case.

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Case information

rID: 47291
Case created: 10th Aug 2016
Last edited: 12th Aug 2016
Inclusion in quiz mode: Included

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