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If you're following the Michael Brown killing (and how many of us aren't?) you may have heard the latest allegation - that Wilson has an orbital floor fracture. Having seen comments in some of the threads looking for information, I thought I'd post some background. I spent many years as an ER doc and have seen my share of these. (Though any ophthalmologist who wishes to add or correct, please do!)

Follow me past the croissant d'orange for the medical scoop.

The orbital rims are strong and it takes a lot of force to break them, in contrast to the orbital floor. The orbital floor is often described as "paper thin" and the amount of force to break it is far less than the rim. Typically, a force is applied that wouldn't break the rim, or is inside the rim, the force is transmitted through the rim or the eye globe itself to the orbital floor, and "blows out" the floor; hence the name "blow out fracture."

Typical causes are thrown balls smaller than the eye socket, contact with fist or elbow, or motor vehicle accidents.

Many people with an isolated blow out fracture require little treatment as long as the muscles that move the eye or the fat pad below the eye don't fall through the broken orbital floor and get trapped there, and there is no damage to the nerve below the eye. If none of these occur, decongestants, pain relief, oral steroids to reduce swelling, and protection from further injury for a few weeks are often sufficient. One well known emergency med source mentions that 85% resolve without further treatment. One source permits return to athletics in 3 weeks.

 If there is one of the above complications, surgery may be needed.

Now on to speculation:
Was Darren Wilson "beaten nearly unconscious" by Michael Brown?
I very much doubt this, given the video of Wilson after the shooting. He appears to be unmarked and walking around normally. I have seen people beaten unconscious or nearly so, and they don't look like this. That's not to say that anyone can't have a vasovagal reaction to a painful event (such as a blood draw) and faint or nearly faint.

Could Darren Wilson have a blow out fracture and appear basically OK initially?
Yes. Some percent of those with such fractures don't seek medical treatment initially - the patient only comes in days later because of a muscle entrapment.

Could Michael Brown have punched Darren Wilson and caused a blow out fracture?
Yes, but with some qualifications. Michael Brown was a big guy, with large hands. To get inside the eye socket usually it's described as "half the size of a fist." Therefore, if he punched, it would definitely have hit the orbital rims, rather than being only within the eye socket. If he hit the thick orbital rim:
1. There should be quite a bit of swelling and bruising on Wilson's face (although an orbital floor fracture alone could result in bruising and swelling). If there was only swelling and no bruising, very unlikely.
2. There should be bruising on Michael Brown's knuckles, which has not been mentioned as found on autopsy (either one).

So, if Wilson does indeed have a blow out fracture, and it didn't come from a punch, what other possibilities?
An elbow, either accidentally during the struggle, or on purpose.
An object in the car that would likely (but not definitely) be smaller than the eye socket.

Edited to add a bit more medical information.

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