Imaging Quiz Answer: Blunt Facial Trauma From a Bungee Jump: Diagnosis
Steven T. Kmucha, MDTHE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 5 - MAY 96
CT revealed a nondisplaced bilateral nasal bone fracture and a left orbital floor fracture (figure 2). Edema of the inferior rectus muscle was noted without herniation of the orbital contents into the maxillary antrum, which contained free fluid. Opacification of some anterior ethmoid air cells and of the left sphenoid sinus was apparent on the CT, along with mild hypertrophy of the mucosa of the maxillary sinuses.
Treatment consisted of oral decongestants, prophylactic antibiotics, and analgesics. The patient was advised to continue applying ice compresses for 48 hours. His recovery was uneventful, with resolution of the limited upward gaze and diplopia. Because of this—and because the nasal bones were not displaced—surgery was not required.
Injuries in Bungee Jumping
Bungee cord jumping is popular in many areas of the country. But because the practice is often illegal, it is often performed in secluded places, at night, or both. It appears that most injuries and deaths result from equipment failure or human miscalculation.
Though reports of death from bungee jumping have appeared in the popular press, a thorough search of the emergency and orthopedic medical literature failed to produce such reports. Personal communication with several local emergency medicine physicians, however, revealed sporadic reports of musculoskeletal injuries of the back and neck related to this activity, which suggests that such injuries occur more frequently than the medical literature indicates.
Socioeconomic and legal issues may account for the dearth of case reports. Minor injuries are perhaps not reported because patients could lose insurance coverage if participation in bungee jumping were documented, and patients may fear legal complications if participation became known.
Fortunately, the patient in this report sustained relatively minor injuries with no permanent sequelae. One can only speculate on the injuries he might have sustained if such a miscalculation had occurred during a jump over land. Extreme caution or complete avoidance is the wisest recommendation regarding activities with such obvious risks.
Dr Kmucha is an attending otolaryngologist at several hospitals in the San Francisco area: Seton Medical Center in Daly City, Peninsula Hospital in Burlingame, Mills Hospital in San Mateo, and California-Pacific Medical Center in San Francisco. He is a clinical instructor in the Division of Otolaryngology-Head and Neck Surgery in the Department of Surgery at Stanford University Medical Center in Stanford, California, and a fellow of the American College of Surgeons. Address correspondence to Steven T. Kmucha, MD, 1800 Sullivan Ave, Suite 604, Daly City, CA 94015.