Case

A 16 year old patient is admitted after having been struck in the face just superior to the eyes during hockey practice. The patient is awake and talking but complaining of severe head pain near his forehead associated with soft tissue bruising. The patient also has blood coming from their right nose.

 

Question 1/3 - What injury(s) does this patient have?

Click on your selected option(s) below  (correct = 2, over-thinking = 3+)

Incorrect. The mandible looks smooth without any discontinuities that would indicate a fracture. The position is symmetrical between the upper and lower teeth, further indicating the absence of significant injury or dislocation.

Correct! There is a 'divot' in the bone of the skull at the midline above the superior orbital rim. There are multiple small fracture lines where the bone has caved in.

Correct!  The broken frontal bone has likely comprimised the frontal sinus, which is also consistent with the nasal bleeding (as the frontal sinus drains into the nasal passages, so bleeding in the sinus could emerge from the nose).

Incorrect. The lateral aspects of the skull appear symmetrical and intact, without discontinuities that might indicate a fracture here.

Possible, but indistinct. The nasal opennings appear symetrical and the nasal bones on the upper part of the nose appear intact. However, there is bleeding from the nose so it is possible there has been small ruptures of vessels within the nose and/or damage to the cartilages of the nose which, since they are soft tissues, do not show clearly on CT scans.