Roof Fractures Research Articles

Mechanism and prevention of coal bursts in gob-side roadway floor under thick and hard roof in the deep mining area of Ordos

The complex stress environment in deep roadways, often exacerbated by thick and hard strata, frequently precipitates coal bursts, posing significant safety hazards. This paper investigates the mechanisms and preventive methods for coal bursts in the gob-side roadway floor (GSRF) under thick and hard roof in the Ordos region, China. First, the stress-distributing characters of GSRF were analyzed then a stress calculation formula was derived. A mechanical model was developed to determine the critical stress for buckling failure of the roadway floor strata. Criteria for the bursting instability of GSRF were then established. The lateral static load from the adjacent gob, the advancing static load from the working face, and the disturbance load from overlying thick and hard roof fractures combine to transmit high loads and energy to the roadway floor via the “roof → rib → floor” pathway, causing increased stress concentration and energy accumulation. When the conditions satisfy the criteria for bursting instability, coal bursts can occur on the roadway floor. To mitigate dynamic load disturbances, the paper proposes roof regional fracturing and abrasive water jet axial roof cutting. Hydraulic reaming of gutters in the roadway ribs and deep hole blasting at the roadway bottom corners are offered to alleviate the static loads on the surrounding rock. The implementation of targeted prevention measures for dynamic and static loads effectively reduces coal bursts in GSRF. These findings offer an example of preventing and controlling coal bursts in other mines of the Ordos region with comparable geological conditions.

Research on “Playing Football” Type Roof Control in Fully-Mechanized Mining Face with a Super-Large Mining Height under the Background of 5G+ Big Data

With the increase of mining height at the working face, the influence range of roof fractures in the goaf increases, the advanced supporting pressure on the coal wall increases, ground pressure becomes more intense, and roof support becomes more difficult. Based on the analysis of ground pressure behavior in the first mining and caving stage, the normal mining stage, and the final mining breakthrough stage of the fully-mechanized mining face near 12,404, the relationship between conveyor current and coal speed is studied and compared. Based on the intelligent control system of the fully-mechanized mining face with a super-high mining height of 12,404 and the structure of the football team, the “playing football” roof control mode of the fully-mechanized mining face with super-high mining height under the background of 5G+ big data is put forward. The conclusions are as follows: In 12,404, the ground pressure was first mined. During normal mining, when the roof with a buried depth of more than 200 m is broken, the speed of the coal machine is kept within 12 m/min, and the full guard defends and controls the roof, pulling the lead frame through the area with severe ground pressure. When the roof is good, it is necessary to speed up the coal cutting and get rid of the pressure. When it is less than 200 m, it will overcome the local weighting, and show an offensive trend to speed up and increase production. In the final mining breakthrough stage, the speed of the coal machine should be controlled within 8 m/min, with attention to defense, guarding against roof leakage, and reducing waste rock.

Clinical characteristics and outcomes of orbital fractures: a sex-based cohort analysis

PurposeThis study aims to identify clinical similarities and differences between males and females presenting with orbital fracture. MethodsPatient charts of adult orbital fracture cases diagnosed via computed tomography and referred by a level 1 trauma center to the McGill University Health Centre between August 2015 to January 2018 were examined and analyzed. Clinical parameters included age, sex, mechanism of injury, morphology of orbital fracture, symptoms and examination features, and rates of ocular pathology. Comparative analyses were performed via Student's t-test and chi-square to assess for sex-related differences. ResultsThe study included 176 males (mean age: 46.2 years) and 68 females (mean age: 58.5 years). The most common etiology of orbital fracture was assault among males (32%) and fall from own or standing height among females (38%). Males had a higher prevalence of bilateral fractures than females (17% vs 6%; p = 0.02) and had more orbital walls fractured per orbit than females (2.0 vs 1.5; p < 0.01). Males were more likely to have their orbital roof fractured (28% vs 15%; p = 0.03) and were more likely to be intubated after their trauma (22% vs 7%; p = 0.004). Post-traumatic ocular pathology occurred in 11% of males versus 9% of females (p = 0.56). ConclusionIn our cohort of adult orbital fractures, males were more prevalent, more likely to have bilateral fractures, more extensive fracture per orbit, and higher prevalence of orbital roof fractures and intubation. Despite these differences, rates of ocular pathology did not differ significantly between males and females, highlighting the importance of a careful assessment in both groups.

The mechanism and prevention of rockburst induced by the instability of the composite hard-roof coal structure and roof fractures

Despite the implementation of prevention and control measures, rockburst still occur. The characteristics of composite coal were analyzed by combining monitoring and early warning means. Two types of composite coal in the hard roof were distinguished based on their distinct initiation and destruction processes despite experiencing the same rockburst event. Rockburst caused by structural instability was studied in different mining stages, and the following conclusions were considered. 1) The mechanical model of the instability of composite coal in hard roof was established for different mining stages to reveal rockburst mechanisms. The high-speed advance of working faces changed the fractured structure of upper hard rocks in the pressure-relief protection range. The sudden fracture of long cantilever structures caused dynamic load disturbance to high-stress coal, which resulted in rockburst in the insufficient mining stage. The failure and deformation of coal under high-stress static loads created conditions for the instability and fractures of roof. The disturbance of low hard rock strata aggravated the deformations of damaged coal. Therefore, rockburst appeared in the full mining stage. 2) Structural instability and roof fracture caused by different factors were the main causes of rockburst for composite coal in hard roof in different mining stages. Relevant prevention and control measures were formulated to ensure the safety of working faces, which provided references for the prevention and control of rockburst in working faces under similar conditions.

Clinical and Surgical Results of Treatment Modalities in Orbital Roof Fractures: Single-Center Experience.

Orbital roof fractures are uncommon craniofacial fractures. Due to the location of the fracture and the mechanism of trauma, it is often associated with neuroophthalmological injuries. The authors aimed to evaluate the results of conservative and surgical treatments of patients with orbital roof fractures and present our clinical experiences regarding optimal treatment planning, especially in cases of moderate or severe head trauma. The authors retrospectively identified 145 patients who were treated for orbital roof fractures. Three colored silicone-injected cadaver samples and a dry skull were used to show the panoramic view of the anatomy of the orbital region. In this study, orbital roof fractures were classified under 4 types. The most common fracture type was type 1 (42%). Intracranial hemorrhage was observed in 60% of all cases and was most common in type 3 fractures (68%). Neuro-ophthalmological deficits were detected in 16% of all patients and were most common in Type 4 fractures (47%). Third cranial nerve deficit was the most common deficit (39%). Neuroophthalmological deficits were detected in 9.5 % of patients with mild head trauma and 32.5% in patients with moderate or severe head trauma. Moderate or severe head trauma was detected in 28% of the cases. Moderate or severe head trauma makes it difficult to detect neuro-ophthalmological complications, which are critical in determining the need for acute surgery. In patients with moderate or severe brain injury, treatment should be individualized according to the nature of the displacement and the relationship between concomitant fractures and intracranial hemorrhage.

Study of the development patterns of water-conducting fracture zones under karst aquifers and the mechanism of water inrush

The hydrogeological conditions of the Qianbei coalfield are complex, and karst water in the roof rock frequently disrupts mining operations, leading to frequent water inrush incidents. Taking the representative Longfeng Coal Mine as a case study, research was conducted on the development pattern of the water-conducting fracture zone and the water inrush mechanisms beneath karst aquifers. On the basis of key stratum theory and calculations of the stratum stretching rate, the karst aquifer in the Changxing Formation was identified as the primary key stratum. It was deduced that the water-conducting fracture zone would develop into the karst aquifer, indicating a risk of roof water inrush at the working face. Numerical simulations were used to study the stress field, displacement field, and plastic zone distribution patterns in the overlying roof strata. Combined with similar simulation tests and digital speckle experiments, the spatiotemporal evolution characteristics of the water-conducting fracture zone were investigated. During the coal mining process, the water-conducting fracture zone will exhibit a "step-type" development characteristic, with the fracture morphology evolving from vertical to horizontal. Near the goaf boundary, the strain gradually decreases, and the instability of the primary key stratum significantly impacts the mining space below, leading to the closure of interlayer voids or the redistribution of water-conducting fissure patterns. Field measurements of the water-conducting fracture zone reveal that postmining roof fractures can be classified into tensile-shear, throughgoing, and discrete types, with decreasing water-conducting capacity in that order, the measured development height of the water-conducting fracture zone (51 m) aligns closely with the theoretical height (51.37 m) and the numerical simulation height (49.17 m). Finally, from the perspective of key stratum instability, the disaster mechanisms of dynamic water inrush and hydrostatic pressure water inrush beneath the karst aquifers in the northern Guizhou coalfield were revealed. The findings provide valuable insights for water prevention and control efforts in the Qianbei coalfield mining area.

Study on the Tensile Failure Characteristics and Energy Calculation Model of Coal Seam Hard Roof Considering the Mining Speed

To reveal the influence mechanism of mining speed on roof fracture-type rockburst, the Brazilian split technique combined with acoustic emission monitoring technology was employed to study the effects of loading rates on the tensile failure characteristics and acoustic emission parameters of coal series sandstone. The linear relationship between the tensile strength of the samples and the change rate of tensile stress was determined. The mining speed was introduced into the mechanical model of initial and cyclic fracture of the hard roof, and the quantitative relationship between the maximum rate of change of tensile stress within the hard roof and the mining speed was derived. Based on this, a computational model for the bending elastic energy of the hard roof during initial and cyclic fractures, considering the mining speed, was established. The main findings are as follows: As the loading rate increases, the distribution range of acoustic emission energy in sandstone Brazilian split samples before failure widens, with a significant rise in acoustic emission ring-down counts and energy at failure. At lower loading rates, acoustic emission events primarily occur near sample failure, whereas at higher rates, they mostly happen in the early loading stage. The higher the mining speed, the less opportunity there is for internal micro-fractures to develop and expand before the hard roof fractures, which macroscopically results in increased tensile strength and a larger amount of energy released at the moment of fracture. Bending elastic energy rises approximately linearly with mining speed, and the thicker the hard roof, the more sensitive the bending elastic energy is to changes in mining speed. This effect is even more pronounced during cyclic fractures. Optimizing mining speed is crucial for preventing roof fracture-type rockbursts, especially in mining workfaces with thick and hard roofs.

Post Traumatic Intra Orbital Encephalocele, a Rare Cause of Pulsating Orbit: Case Report

Orbital trauma is a prevalent condition in clinical practice, particularly in situations of head trauma. Orbital roof fractures following a blunt trauma are an uncommon consequence of trauma. Traumatic encephaloceles in the orbital cavity are much more uncommon, with only a few examples reported to date. Early detection and therapy of raised intraorbital pressure can avoid irreparable optic nerve injury. In trauma patients with concomitant orbital injuries, orbital computed tomography (CT) with thin axial and coronal slices is beneficial. Decompression of the orbital roof is the most important stage in surgical therapy and should be done in all cases. We report the case of an adult with a post-traumatic orbital encephalocele. A few hours after a road traffic accident with head injury, the patient developed progressive pulsatile enophtalmosis. Computed tomography revealed multiple fractures of the orbital rim with herniation of the left frontal lobe into the orbit.

Clinical characteristics and associated features of pure orbital roof fractures: A ten-year retrospective review

PurposeTo present the demographics and clinical characteristics of pure (rim-sparing) orbital roof fractures. MethodsThis retrospective observational study used 10 years of data from a single institution. Patient age, sex, laterality, field of binocular single vision, associated injuries, and radiologic features were analyzed. Orbital roof fractures were categorized into four groups: comminuted/open, hinged, trapdoor, and linear. These were further subdivided into blow-in (-down) and blow-out (-up) fractures. Injury etiology was classified into fall, traffic accidents, sports injuries, assault, work-related, and others. ResultsData documented a low incidence rate of 2.5% (27 patients) in 1074 patients. Most patients were male (81%). The most common cause of injury was fall (48%), followed by traffic accidents (22%). Comminuted/open fractures constituted the bulk of fracture types (54%), followed by hinged, and linear fractures. Blow-in and blow-out fractures had an incidence rate of 50% each. Concomitant fractures of the medial and inferior orbital walls were predominant. Low surgical intervention was noted owing to acceptable field of binocular single vision outcomes, and the field of binocular single vision included the primary position of gaze in 88% of patients. ConclusionPure orbital roof fractures occurred in 2.5% of patients with pure orbital fractures. Patients were predominantly male with trauma caused by high energy forces, which regularly caused comminution of the roof and fractures of the medial and inferior orbital walls. Most patients were managed conservatively.

Case Report of a Post-Traumatic Orbital Encephalocele in an Adult

Orbital encephalocele is a rare severe and sight-threatening complication of orbital roof fractures that can be challenging to diagnose, we present the case of a 56-year-old man suffering from post-traumatic orbital encephalocele.

Early Surgical Management of Displaced Orbital Roof Fractures: Prospective Observational Study

Early Surgical Management of Displaced Orbital Roof Fractures: Prospective Observational Study

Spontaneous Repositioning of Significant Blow-out Orbital Roof Fracture Associated With Intracranial Hematoma.

Orbital roof fractures are relatively rare facial bone fractures that usually occur in conjunction with other facial bone fractures or intracranial hematoma during high-velocity facial trauma. This study reports a patient with a significant blow-out orbital roof fracture combined with a nondisplaced frontal bone fracture and epidural hematoma at the superior aspect of unilateral frontoparietal convexity. Despite the severe superiorly-displaced fracture segment, the follow-up computed tomography scans taken 4 days after the injury showed a spontaneous reduction of blow-out orbital roof fracture. At the 1-week follow-up, the coronal image of craniofacial magnetic resonance imaging was taken, showing spontaneous realignment of orbital roof fracture and physiological evolution of cerebral contusion. In conclusion, conservative treatment can acquire the best outcome regarding cosmesis and function unless the patient requires an emergent operation for other medical conditions. This is key for successfully returning the patient's form and function.

Investigation into Occurrence Mechanism of Rock Burst Induced by Water Drainage in Deep Mines

Confined aquifers widely exist in the strata of the Ordos mining area. Water drainage before mining is an effective measure to avoid water inrush disasters caused by the connectivity between mining-induced roof fractures and aquifers. However, rock burst disasters occur frequently in the mining process of many water drainage working faces. The statistics show that the surrounding rock of nine water drainage working faces in five mines has suffered different degrees of rock burst, which seriously restricts the safe, efficient production and sustainable development of ten-million-ton modern mines in China. Based on this, taking the 22,106 longwall working face (LW22106) of the Shilawusu Mine, Ordos, as the engineering background, this paper investigates the occurrence mechanism of water drainage on rock burst in the roof water-rich area by using theoretical analysis, similar material simulation, microseismic measurement and other methods. The main conclusions are as follows: (1) After the drainage of the water-rich area, the pressure relief zone, pressurized zone and pressure stabilization zone are formed in sequence from the center to both sides. The width of the pressure relief zone is consistent with that of the water-rich area, and the width of the pressurized zone is about 35 m on one side. (2) When the mining is passing the pressurized zone, the coal rock mass is under the joint influence of gravity stress, mining disturbance stress and drainage transfer stress. The superimposed stress generally exceeds 2.5 times the uniaxial compressive strength (UCS) of the coal rock mass, and the maximum reaches 3.24 times, far exceeding the critical value of rock burst (1.5 times UCS), which is the main reason to induce rock burst. (3) The dynamic change in the rock burst risk areas before and after drainage in water-rich area no. 4 has been predicted, and the number of risk areas increases from 4 before drainage to 13 after drainage. Since the stress superposition effect differs due to different mining speeds, it is proposed that the dynamic regulation of mining speed in the front and at the back of the drainage area is an effective and efficient method for rock burst prevention and control. The research results will provide a theoretical basis and technical support for the prevention and control in the roof water-rich area of deep mines.

Roof Fractures of Near-Vertical and Extremely Thick Coal Seams in Horizontally Grouped Top-Coal Drawing Method Based on the Theory of a Thin Plate

During the mining process of the near-vertical seam, there will be movement and collapse of the “roof side” rock layer and the “overlying coal seam,” as well as the emergence of the “floor side” rock layer roof which is more complicated than the inclined and gently inclined coal seams, which causes problems with slippage or overturning damage. With the increase of the inclination of the coal seam, the impact of the destruction of the immediate roof on the stope and roadway gradually becomes prominent, while the impact of the destruction of the basic roof on the stope and the roadway gradually weakens. The destruction of the immediate roof of the near-vertical coal seam will cause a large area of coal and rock mass to suddenly rush to the working face and the two lanes, resulting in rapid deformation of the roadway, overturning of equipment, overturning of personnel, and even severe rock pressure disaster accidents, all of which pose a serious threat to coal mine safety and production. It is necessary to carry out research on the mechanical response mechanism of the immediate roof of near-upright coal seams, to analyse the weighting process of steeply inclined thick coal seam sub-level mining. A four fixed support plate model and top three clamped edges simply supported plate model for roof stress distribution are established before the first weighting of the roof during the upper and lower level mining process. The bottom three clamped edges simply supported plate model and two adjacent edges clamped on the edge of a simply supported plate model are established for roof stress distribution before periodic weighting of the roof during the upper and lower level mining process. The Galerkin method is used to make an approximate solution of deflection equation under the effect of sheet normal stress, and then roof failure criterion is established based on the maximum tensile stress strength criterion and generalized Hooke law. This paper utilizes FLAC3D finite element numerical simulation software, considering the characteristics of steeply inclined thick coal seam sub-level mining. It undertakes orthogonal numerical simulation experiment in three levels with different depths, coal seam angles, lateral pressure coefficient, and orientation of maximum horizontal principal stress, and translates roof stress of corresponding 9 simulation experiment into steeply inclined roof normal stress. We conclude that the distribution law of normal stress along dip and dip direction of a roof under the circumstance of different advancing distances and different sub-levels. The caving pace of first weight and periodical weight were counted under the effect of the roof uniform normal stress. It can better predict the weighting situation of the working face and ensure the safe, efficient, and sustainable mining of coal mines.

Calibration of Water Inrush Channel and Numerical Simulation of Water Inrush Process in Coal Mine Roof

The surrounding rock of a coal mine roof fractures with the excavation of the underground working face in coal mining. These mining-induced fractures are connected and extended upward to form water inrush channels. A water inrush accident may occur when there is a sufficiently large water source. To elucidate the formation mechanisms of the roof water inrush channel and the characteristics of water inrush in goafs, we performed a case study of No.18401 Panel of Xiqu Coal Mine in China and determined whether the roof water inrush channel is connected by theoretical calculation and microseismic monitoring. The modified mechanical parameters of rock masses were embedded into the numerical model based on microseismic data. Microseismic monitoring and numerical simulation were organically combined to analyze the connection process of the water inrush channel, after which the roof water inrush channel is calibrated on the No.18401 Panel. We established a non-Darcy flow model for water inrush in the water-conducting fractured zone of mines by coupling the Darcy, Forchheimer, and Navier–Stokes equations. Finite element language and its compiler (FELAC) was used to study the water inrush mechanism of non-Darcy seepage. The results show that the pressure, velocity, and porosity in the water-conducting fractured zone are non-uniform in water inrush occurrence and development, and the mixed fluid mainly passes through the “dominant channel.” The development of water inrush is accompanied by the release of the hydrostatic pressure in the aquifer, the sudden increase of the velocity at the water inrush position, and the increase in fluid concentration. Hence, the underground water inrush can be predicted and prevented by monitoring the aforementioned indicators. This research is of great significance for the calibration of the water inrush channel of the roof and the prediction of water inrush disasters.

Successful Management of Post-Traumatic Residual Orbital Roof Defects with Cosmetic Disfigurement and Functional Deficits Using Innovative Titanium Plate Orbitoplasty.

Late presentations of post-traumatic residual orbital roof deformities ensuing from old, unaddressed orbital injuries, can be extremely challenging to manage and quite complicated to correct, owing to proximity of the brain and frontal sinus, malunion or bony fusion of the displaced, delicate orbital fracture fragments, necrosis of entrapped extraocular muscles and progressive intraorbital soft tissue fibrosis and adhesions. There exists a paucity in literature on delayed repair of displaced and comminuted orbital roof fractures and late reconstruction of the three-dimensional architecture of the orbital frame and internal orbit. To present an unusual case of severe post-traumatic residual orbital roof deformity, resulting in longstanding aesthetic disfigurement and persisting functional deficits, and its successful management. The patient had sustained orbital injuries sixteen months ago, on being punched in the face at a boxing tournament. The increased orbital volume produced by an impure blowout fracture of the left orbital roof, with comminution of the upper and lower orbital rims, had resulted in considerable cosmetic deformity, discomfort as well as functional debility, all of which were successfully and efficaciously managed by an innovative use of a Titanium Orbital Plate for orbital roof reconstruction. Overlooked, undetected or ignored derangements in intraorbital volume and contour, can lead to severe cosmetic disfigurement in the form of enophthalmos, hypoglobus, entropion, telecanthus, palpebral fissure width narrowing and ptosis; in addition to crippling functional deficits, such as diplopia, blurred vision, levator dysfunction, restricted ocular motility and reduced visual range and acuity. An innovative Titanium mesh orbitoplasty enabled achievement of both, the aesthetic and functional goals of reconstruction of the distorted bony orbit, with successful correction of severe functional and aesthetic deficits.

Supramuscular upper blepharoplasty approach to orbital roof and/or lower anterior table frontal sinus fractures: A meta-narrative review

BackgroundAn approach to orbital roof fractures (ORFs) and/or lower anterior table frontal sinus fractures (LATFSFs) is a challenging task. The conventional coronal approach (CCA) appears to suit multiple/complex fractures of the upper face, while periorbital transcutaneous incisions (PTIs), e.g. gull wing, open sky, butterfly, and Lynch incisions, often impair aesthetic outcomes. The aims of this paper were to provide an overview of the supramuscular upper blepharoplasty approach (SUBA) to ORFs/LATFSFs. MethodsUsing a meta-narrative review study design, the investigators enrolled published data extracted from PubMed/Medline, Embase, Cochrane Library, and Google Scholar concerning SUBA to ORFs/LATFSFs. Only publications with the highest and most recent level of evidence (LoE) in English, French or German available until 6 May 2022 were included. The LoE were evaluated using the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM)’s classification. ResultsIn total, 70 articles were included; however, most contained low LoE. Under general and local anaesthesia, SUBA to ORFs/LATFSFs can be performed safely and appeared to be superior to its submuscular counterpart in terms of fewer risks of adjacent tissue injuries, and speedy operative time (maximal 5 min. in experienced hands). ConclusionsIn contrast to CCA and PTIs, the SUBA is a minimally invasive approach to the ORF/LATFSF with favourable aesthetic outcomes, direct visualisation of the fracture, quick operative time, rare complications, and easy learning.

The Spatial Evolution Law and Water Inrush Mechanism of Mining-Induced Overburden in Shallow and Short Coal Seam Group

In order to grasp the overburden evolution law of the shallow and short coal seam group, based on the key bed theory, a mechanical analysis of the longitudinal expansion of mining-induced overburden fractures in the coal seam group was carried out, and the spatial evolution characteristics of mining-induced overburden fractures were simulated by the numerical simulation method. The results show that in the process of working face advancement, with the continuous instability and failure of the overburden, the size and shape of the fracture network are also changed. The repeated mining of the lower coal seam further causes the secondary activation of the upper overburden, which makes the roof fractures of the partially compacted goaf violently move again. The “channel source” and “space source” continue to carry out the process of “generation-expansion-compression-generation-expansion”, in combination with pore fracture elastic theory. The water inrush characteristics of the whole coal seam are divided into three “solid-liquid” coupling stages: the original gap seepage stage, the initial water discharge stage of mining fissures and the water inrush stage of fractured rock mass. The steady value of water inflow and its variation characteristics with time are predicted by using the formula of deep well flow in a confined aquifer.

South Texas orbital fracture protocol for emergency department evaluation of orbital fractures

PurposeFacial trauma and orbital fractures are common reasons for ophthalmology consultation in the emergency department (ED). The purpose of this study is to assess intervention rates and evaluate the acuity of ophthalmology consultation for orbital fractures in the ED. Basic proceduresA retrospective chart review of orbital fractures was conducted over a 23-month period. 379 cases of orbital fractures were identified in a single-center study. All patients that received an ophthalmology consultation in the ED were included. Demographics, mechanism and location of orbital fracture, ophthalmic complications, and surgical and non-surgical ophthalmic interventions were recorded. The primary study outcome was the rate of ophthalmic consultation and intervention with and without retrospective application of our proposed South Texas Orbital Fracture Protocol (STOP). ResultsImmediate ophthalmic intervention was performed in 18.7% of patients. Statistically significant subjective, radiographic, and physical exam features correlating with ophthalmic intervention were identified and included globe rupture, concern for entrapment, orbital roof fractures, and retrobulbar hematoma. Retrospective application of our proposed South Texas Orbital Fracture Protocol (STOP) would have resulted in 186 of 379 patients requiring ophthalmology consultation, thus reducing consultation rate by 51% with an improved rate of intervention from 18.7% to 37.6%. ConclusionsOrbital fractures can be associated with severe ocular complications. Most cases, however, do not require emergent evaluation by an ophthalmologist. We propose the South Texas Orbital Fracture Protocol (STOP) for proper assessment and triaging of orbital fractures in the ED. While this clinical decision-making tool requires validation, it may offer improved healthcare efficiency, reduced costs, fewer unnecessary inter-facility transfers, and less burnout for ophthalmology residents.

The Management of Orbital Roof Fractures and Defects: A Review.

To explore the anatomy, etiopathogenesis, diagnosis and classification, current evidence on intervention and the surgical management of orbital roof fractures and defects (ORFD) for oculoplastic surgeons presented with such cases. A review of the current literature through the MEDLINE database using the following search terms: "orbital roof fracture (+treatment/management)," "orbital roof defect (+treatment/management)," "orbital roof erosion (+treatment/management)," "orbital roof repair," "orbital roof," "orbital fracture," "pediatric orbital roof (defect/fracture/erosion)," "orbital anatomy," and "orbital roof anatomy" was conducted. As relatively little has been published on this topic, inclusion criteria were broad and peer-reviewed articles judged to be of clinical importance, relevant to the aims of this review, were included. Non-English abstracts were also included if relevant. Year of publication was not a strict exclusion criterion, and older articles were judged for their suitability based on clinical importance and relevance to current practice. Additional references were obtained from citations in key articles and recommendations from the coauthors based on their areas of expertise. The etiopathogenesis of ORFD varies. Classification systems have been formulated to guide management decisions and can range from conservative management to complex neurosurgery. Eyelid approaches have also been described. This review provides a summary of the evidence for each and a management framework oculoplastic surgeons can use when presented with ORFD. Oculoplastic surgeons can be involved, either alone or as part of a multidisciplinary team, in the management of ORFD, and for some, conduct orbital approach reconstructive surgery.