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  1. #1
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    Blow-out fracture experience? Eye socket

    Anyone have personal or professional experience with blow-out fracture under the eye to share? Victim curious about what's what with the procedure.

    Narrative: My wife Gianna had a dog slam her rear wheel today, pretzled an American Classic. Flipped the rear of the bike out from under her at a pretty good speed. She's got the usual abrasions, but really slammed her face into the road hard. Helmet is toast (they're very good aren't they - I saw the impact in my rear view mirror and thought she was likely dead). Tifosi saved her eye (big scuff across the lens). She took the main blow into her cheek and eyebrow. Gave her a number of minor facial fractures and a blowout fracture of the orbital floor. Think that's the terminology the ER doctor gave. Anyone have any personal or professional experience with this? I read online, but that's pretty dry stuff. She'll see the surgeon on Friday. Can have the surgery pretty soon if we can get the swelling down. She's still got her right eye swollen shut and purple. Very curious about what happens, recovery times, etc.

    I think she'll be able to ride shortly except for the eye stuff. That and not having a bike. Need to get that estimated. She'll also need to replace the 2007 DA brifters (one almost sawed through by the road), her new Sidi Genius 5 shoes, her nice jersey, helmet, gloves were cut through (she'll have scarring on her hands I'm sure - deep abrasions on the knuckles), glasses ruined. So I figure she's off the road until perhaps mid October. Can still get some of the fall in.

    At least she's alive and walking around. And had a nice mellow backboard ambulance ride.
    Last edited by mandovoodoo; 08-28-2007 at 07:22 PM.

  2. #2
    Matnlely Dregaend
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    Sorry to hear about your wife. I have only secondary experience with blowout fractures (I'm only peripherally involved with trauma cases like that) but the patients I do see who have had this happen to them appear to recover quite normally. The blowout is usually suborbital and the surgeon will place a mesh like implant to keep the eyeball from sinking out of the socket. Recovery time should be a few weeks.

  3. #3
    RoadBikeReview Member
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    I'm not sure if this is the same injury or not but in 1985 I had a 3-wheeler crash that smashed my eye socket and cheek bone and 1/3 of my forehead, spent 5 days in the hosp. 1st 24 hours waiting for the swelling to go down before surgery.when I woke after surgery I had a surgical tubing hanging out of my nose.The doc said that it went up into my sinus cavity to hold my eye from slipping back downward, holding it in place.He wired everything else back together.
    2-weeks later I went back and had balloon removed.for a year or two had some nerve damage on my face,weird thing was when I ate ice cream I felt the cold on the out side of my face.
    fast forward 20 plus years no problems what so ever.Also I'm sure they have improved many or all of the techniques now. in this case I have to say that docs rule

  4. #4
    chica cyclista
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    Quote Originally Posted by mandovoodoo
    At least she's alive and walking around. And had a nice mellow backboard ambulance ride.
    god mando, I'm sorry to hear about the crash and injury. Good to hear she'll be okay in the long run. Sounds like a scary, scary injury. I can't help you with info on the injury. Good mojo to you, and hope your wife heals up fast with minimal scarring.

    Were you able to find the dog owner? This is the sort of thing I fear the most with the trail users out here on the local open space with their large, uncontrolled, unleashed dogs who insist "oh he's FRIENDLY... he's just PLAYING..." They truly have no clue.
    Grandpa LFR: "Kid, don't wrestle with pigs; you'll just get covered in crap, and the pig enjoys it."

    /Grandpa LFR

  5. #5
    RoadBikeReview Member
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    <>

    And some people can't be bothered with wearing gloves.

  6. #6
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    Dog owner was standing there. Think she called out to the dog. Something attracted my attention so I was looking at my mirror right as the impact happened. She then admitted attempting to stop the dog. Offered help. Admitted dog ownership. I don't see why there would be a problem in getting resolution started. Getting the right amount back I'll need help on - it's a long process to see whether there's permanent damage or not. I'll ride out there today and see if I can get their liability carrier contact point, policy number, etc. I've got a log of costs, including mileage, my time, her time (we're self employed, so no "fixed" salary). Haven't touched the bike, not cleaning her clothes, we've written narratives in detail, etc. I don't imagine I'll have to sue. Will call our medical carrier today once I have the liability carrier information and get the medical cost recovery started. I've not had a personal injury case, so I'd pull in a friend of mine if there's any trouble. He's quite nasty, thoroughly insistent and unpleasant fellow, in a very polite way.

    And gloves, great she had them on, but she hit the back! So they did just a little good. Overall, the protective gear did very well. Helmet clearly took a good strike. Shell got scuffed and is depressed a little, but didn't tear. Foam didn't break. Stayed in position. Glasses spread the impact around her eye socket rather than than tearing her eye apart. High end jersey took a bunch of abrasion before tearing - sort of shredded. Might be down to bone with a weak jersey. Shorts barely scuffed, the skin damage starts right at the shorts line. The gloves were actually the weak spot, but they still took a good slam to get shredded. Her knuckles moved along the road, pretty clear on that.

    The dog hit her hard enough to warp the Am Classic rear wheel pretty badly. Good blow. Figure there's a good deal of damage to the bike. I think the DA brifters are high $$$ and I doubt Am Classic wheels are cheap. Haven't checked for other damage. Need to get the carbon evaluated, too, although I suspect there's no problem. Haven't looked for tube dings either (mixed al/carbon bike).

    She looks a bit better this morning. Swelling a bit further down. Still can't open her eye. Has the dressing off her chin. Nasty. Don't know if she'll end up with facial scarring. I suppose facial and hand scarring is worth something in a settlement.

    Looks like I'll be cycling alone for a while. I don't think she'll be able to risk another blow until this damage is completely healed. And she's in such good shape! Did the livestrong Challenge on Sunday in 7 hours, including taking her time and stopping at every rest stop. Probably under 6 hours of riding. She's as fit as I've seen her. We were looking forward to some long rides this fall. Guess the Clarksville Century this weekend is out!

    If anything interesting develops I'll post it here.

  7. #7
    Windrider (Stubborn)
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    Man...sorry to hear about that....glad she'll be OK in the long run.

    Len



    "Evil....is the complete lack of Empathy!"

    ""We are what we repeatedly do. Excellence, then, is not an act but a habit. " Aristotle

    No one is as bad as the worst thing they have done & no one is as good as the best thing they have done.........think of that when you feel like you understand someone.

  8. #8
    Fat'r + Slow'r than TMB
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    Count your blessing my friend. I had a moment this weekend where my wife got inches from being a hood ornament and then I read 3 post post about folks being hit or falling all in the first 5 minutes of opening RBR. Not a good way to start my week. Just from the reading I was quickly able to look at this AM, it looks like a wait and see scenario. Need for surgical intervertion - rarely indicated immediately, 85% resolve without surgical intervention, typically observed for 10 -14 days until swelling resolves. Be sure to get good follow up with maxillofacial surgery, opthalmology for any eye issues, and maybe plastics later on down the road for scarring issues. Anyway, good luck.

  9. #9
    triathlon hopeful
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    My buddy got sucker punched by a complete stranger while walking by Niagara Falls with his g/f last year, he didn't even know what happened. Went to the hospital and said he had about 10 fractures around his eye. Doctors told him that if he get hit in the eye again before it heals that it could shatter his eye socket. So be very careful untill it heals.

  10. #10
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    Home Owners Insurance

    Mondo, had a similar situation with my training partners wife. Broke hip, ER visit. Bills pile up quickly. The dogs owners home owners insurance paid. Over 75K and she didn't have surgery. My advice to you would be get legal representation immediately! My .02. I just got bit and crashed last Wednesday. Bad week for dogs...

    Lew

  11. #11
    goodbye fraudriguez
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    Orbital blowout needs repaired if there is double vision, restriction in extreme gaze, or if the eyeball sits lower, or deeper. Can't tell much until the swelling comes down. Keep her head elevated (sleep on pillows) and use ice packs. Surgery is usually done via the lower eyelid for an isolated injury. Orbital floor will need rebuilt, hopefully using the existing bone, her own cartillage, or other material like Gortex or artificial bone. Take your CT scan to the appt.

    I pray all goes well for her.
    mountaineer

  12. #12
    Folsom City Blues...
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    Though I can’t offer any aid with your wife’s situation, I’m so very sorry to hear this terrible bit of news. I see potential for dog and cyclist collisions on my rides way more then I’m comfortable with, most can be avoided, but getting hit from the back like that really makes me uneasy.

    I mean what in the heck can you do? The dog hit the back wheel! If you don’t mind me asking, do you know what breed of dog it was? Was it a good size dog?

    On a last note, I wish your wife a very speedy recovery and hope the legal side of things goes as smooth as possible for you and yours…

    Peace
    Tao Te Ching

    The movement of the Tao is to return
    The way of Tao is to yield

    Heaven, Earth and all things

    are born of existant world.

    The existent world is born of nothingness of Tao

    Master Lao Tzu

  13. #13
    Alien Musician
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    Exclamation Holy moly!

    Sorry to hear what your wife has undergone. Keep us posted on it, I hope she heals up
    nicely and I hope the dog owner has learned something too. I think the damage seems
    incredible - that had to be a hell of a dog if the rear wheel was bent like that.

    Tell her there's a bunch of us pulling for her.

    Bad week for dogs, bike collissions and other similar stuff.

  14. #14
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    Great Dane moving fast - Gianna says it was a big hit, knocked the bike out of control instantly. I saw the front wheel turn about 20 degrees instantly. Much more than a bike will handle at cruise speed. That's about when the rear end kicked up. Probably a combination of the dog continuing under the wheel and the bike throwing itself over the front wheel. She didn't let go.

    Big dog, big impact. Rear wheel wouldn't turn with the brakes tight, just barely clearly with the brakes loose.

    Her eye is open again, no distortion, no double vision, so possibly this will be a wait and heal thing. Have an appointment with the specialist Friday, so we'll see what he has to say.

    isaw

  15. #15
    RoadBikeReview Member
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    inferior orbital wall fracture is pretty harmless unless it affects the function of the eye or the orbital muscles or cause significant cosmetic changes. A lot of time, nothing is done. I saw alot of orbital fracture in my residency and still see a one now and then.
    Your wife may have some nerve damage (specifically the inferior orbital nerve) affecting the sensation to her cheek.
    Make sure her eye is OK. Have an ophthalmologist look at it.
    if surgery is done, she will have a nice Titanium plate in her orbit.
    good luck

  16. #16
    RoadBikeReview Member
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    Man, sorry to hear about your wife. I hope she gets well soon.

    Im thinking about spraying these 2 dogs on my route with some mace or pepper spray next time i ride. The damn owners keep laughing when they chase us.

  17. #17
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    I'm so very sorry to hear of your wife's accident. These dang dogs (dog owners to be precise) really chap my hide. I'm wishing her an uneventful and speedy recovery, and that all the expenses will be taken care of promptly. What a hassle, sorry.

    4 wks ago a pack of four came running out, two from behind, and I was cooking along at a good clip. Managed to get myself stopped before the collision, but they had me surrounded, growling, snapping and charging for a good three minutes. I had no choice but to stand there surrounded until the lazy owners, who happened to be in the back yard finally called for them. I'm not normally a swearer, but I let it rip when they came out.

    After this, and having been bitten twice, I have begun informing people in my area that if I am bitten, attacked, or charged causing a crash/injury, I will own their property outright. Surprisingly people understand this language better than, "gee, could you please make an effort to keep your animal confined?"

  18. #18
    Folsom City Blues...
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    Quote Originally Posted by mandovoodoo
    Great Dane moving fast - Gianna says it was a big hit, knocked the bike out of control instantly. I saw the front wheel turn about 20 degrees instantly. Much more than a bike will handle at cruise speed. That's about when the rear end kicked up. Probably a combination of the dog continuing under the wheel and the bike throwing itself over the front wheel. She didn't let go.

    Big dog, big impact. Rear wheel wouldn't turn with the brakes tight, just barely clearly with the brakes loose.

    Her eye is open again, no distortion, no double vision, so possibly this will be a wait and heal thing. Have an appointment with the specialist Friday, so we'll see what he has to say.

    isaw
    Dang, might as well been a small horse. Thatís a mighty big animal to let lose without a leash. I canít even begin to imagine a dog that size running loose, let alone tackling the back end of a bicycle wheel. Much good vibes to your wife on a speedy recoveryÖ

    Peace
    Tao Te Ching

    The movement of the Tao is to return
    The way of Tao is to yield

    Heaven, Earth and all things

    are born of existant world.

    The existent world is born of nothingness of Tao

    Master Lao Tzu

  19. #19
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    sI have had two friends who have had orbital blowouts, one in a bad fall while on a boat, the other in a bizarre, doubles-tennis accident. Both had surgery, and have done well, no side affects, once recovery was complete. Good luck to your wife, I bet she will do fine.

  20. #20
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    Things are shaking down a bit more clearly. Spent the morning in the ER. She had a hand swell up. XRays, no biggie, nothing broken, just jambed it probably. So she's lying here mostly asleep while I change the ice on her hand and face every now and then, letting things warm up in between.

    Facial injury is way reduced in swelling. She's got some of the nerve damage mentioned above. Substantial loss of feeling. Eyes track the same. No eye damage we can see. As soon as she can actually hold her eye open we'll get it checked out thoroughly. Friday appointment w/restoration specialist for the bone. See if surgery required.

    Will get the bike and gear estimate tomorrow in writing. I could do it, but there you go. Need that "shop" letterhead.

    State Farm (their insurer) seems very willing to cooperate.

    I rode out today and looked at the spot. No way to see a dog or horse coming. Stuff along the edge of the yard by the road past the fence/tree line with the next lot. Tractor, bushes, etc with dog size gaps. So the dog shot out from right, went for me, turned towards her, she went to far left of road and popped forward. Dog tried to stop or turn, but was big and goofy, slammed the rear wheel hard enough to bend the rim badly, torquing the front and forcing the head tube right, turning bar/fork to left LOTS (I saw the sudden torque over) and driving the whole bike forward over the front wheel contact point. She just levered into the ground hard.

    I think this will add up. Jersey, Sidi Genius 5, American Classic, DA brifters, two ER visits, ambulance, surgery, post-op work, lost work time, maybe cosmetic surgery, maybe permanent loss of some feeling, permanent scarring (probably on her hands at least). I don't have any idea how to value some of this. Will call some of my personal injury friends. They'll know how to value this stuff.

    She really looks like hell. I've got images immediately post wreck, in the ER. If I get a chance I'll post one. But today she's walking around and looking much better. People didn't gawk too much at Kroger. I'm impressed at how incredibly tough she is. She's 43, mother of 2, just rode her first century, and you'd never know it. Looks like she's ridden her whole life, beautiful on the road. And she nearly pulled off the evasion from this ambush. Then hit perfectly for a lethal header, spread the impact out. Didn't even snap off any teeth! Just incredible. She's got great focus and reflexes. I'm honored to ride with her, even if I have many 10s of thousands of bike hours on her.

    Thanks for the support. Difficult for me. I really thought she was dead. Now I'm running her, the business, the kids, the house . . . . Single dad plus nurse all in one. But she'll be running again shortly!

  21. #21
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    Well, it's obvious she's got a great guy to look after her. Good for you, I know she must be relieved you're stepping up to the plate to take care of everything and this will speed along the healing process.

    My wishes and prayers for you, too during the time you've got to cope with all this mess.

  22. #22
    RoadBikeReview Member
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    Prayers sent for you all.

  23. #23
    It's not easy being green
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    Surgery is easy

    Six years ago I was kicked in the face by my horse. My orbital bone was fractured and I needed surgery. The bone is so thin, like egg shell, if it's broken a CT or MRI will show a big black space where the bone should be. My vision was never impaired, but it hurt looking up and down. The swollen muscle was the only thing holding my eye up. The surgery was done by a plastic surgeon, a small incision under the lower lid and all the old bone taken out. I have a 2 inch by one inch implant, like styrophome, with a titanium screw in my face. I haven't had any problems with any of it. Tell your wife not to worry, she's tough and the surgery is a piece of cake. I think she deserves a new bike out of this. Good luck and a speedy recovery.

  24. #24
    RoadBikeReview Member
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    Quote Originally Posted by kermit
    Six years ago I was kicked in the face by my horse. My orbital bone was fractured and I needed surgery. The bone is so thin, like egg shell, if it's broken a CT or MRI will show a big black space where the bone should be. My vision was never impaired, but it hurt looking up and down. The swollen muscle was the only thing holding my eye up. The surgery was done by a plastic surgeon, a small incision under the lower lid and all the old bone taken out. I have a 2 inch by one inch implant, like styrophome, with a titanium screw in my face. I haven't had any problems with any of it. Tell your wife not to worry, she's tough and the surgery is a piece of cake. I think she deserves a new bike out of this. Good luck and a speedy recovery.
    Thanks! That's reassuring. She was actually on her new bike - probably 500 miles on it, tops.

    Here's her recollectin: http://livestronggianna.blogspot.com/

  25. #25
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    Ah, I must have misunderstood or misinterpreted. Detailed work today showed a standard smashed in cheek bone, breaks in the usual places. Some displacement at the bottom of the eye socket, but her eye works fine. No damage there. Depression amount is getting more clear with every reduction in swelling. Looks like 1/8". She's going to get the surgical fix, in through her mouth mostly. Probably 2 Ti. plates, small ones.

    She's getting feeling back. This is good. But the pain is coming in very strongly from the face damage. She's on hydroconone?? Something strong like that, and still miserable. Her bent tailbone is also making things difficult.

    Surgery is Wednesday. She'll swell up again, no doubt, and have pain again, no doubt. But the surgeon says she'll heal very quickly. He's impressed with her recovery and her general conditioning (so am I). Says she can cycle again within a week after the surgery.

    And I'm trying not to be a wreck. Very demanding week. I got a ride in this evening, though, and nobody tried to kill me with a car. My nice little bike is like a jet fighter. A good break. There's ultimately nobody else to count on but me in our house or business.

    She can't even type really - I sat and did all the sales invoices today. Filled out medical forms. She can sign things. But one hand is still swollen up. The areas that a pen contacts are very raw. She has deep abrasion damage. Her chin looks like crap, too. I hurt her by mistake today. Told my son's teacher we were on the way to get her fitted for a 1/2 mask - the teacher is a Phantom of the Opera fan. Cracked them both up, but smiling hurts poor Gianna!

    I suspect she'll end up with scarring on her hands, maybe on one knee. Possibly on her chin. If some additional incisions are required, maybe other scars. She's not vain or anything. She cried at the surgeon's office - said she just wanted to look the way she did before. She used to be a model with a big fan base. She doesn't miss it, but she doesn't want one side of her face squished in.

    Anyway, thanks for the support. Difficult to see her suffer. I should post a couple of images. She was pretty beat up.

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