A young guy comes to the ED after a car crash. While he was driving, the car in front of him stopped abruptly so they crashed. Fortunately speed was low and he does not report major trauma, but a black eye due to an impact towards the airbag. You promptly evaluate his sight and find no deficit, no diplopia, palpation does not show fracture steps or enphysema, skin sensation is preserved.
It’s nothing, just put a cold steak on it!
Would you really say this?
Conclusion
As you can easily see in the pictures above, all this clinical signs are very specific but poorly sensible, a recent study by Büttner M, et al. shows that the prevalence of fracture, in patient with a minor head injury (GCS>13) with a black eye, is more than 66%, this sign alone shoul lead to a CT investigation.
Bibliography
Büttner M, et al.
Is a black eye a useful sign of facial fractures in patients with minor head injuries? A retro-spective analysis in a level I trauma centre over 10 years.
Br J Oral Maxillofac Surg (2014)
http://dx.doi.org/10.1016/j.bjoms.2014.03.018
