Semi-closed reduction of tripod fractures of zygoma under intraoperative assessment using ultrasonography

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2009-04, Vol.62 (4), p.499-505
• Main Authors: Soejima, Kazutaka, Sakurai, Hiroyuki, Nozaki, Motohiro, Kitazawa, Yoshihiko, Takeuchi, Masaki, Yamaki, Takashi, Kono, Taro
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Bone Plates; Bone Wires; Closed reduction; Female; Fracture Fixation, Internal - methods; Humans; Injuries of the limb. Injuries of the spine; Intraoperative assessment; Male; Medical sciences; Middle Aged; Minimally invasive procedure; Minimally Invasive Surgical Procedures - methods; Plastic Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Treatment Outcome; Tripod fracture of zygoma; Ultrasonography; Ultrasonography, Interventional - methods; Young Adult; Zygomatic Fractures - diagnostic imaging; Zygomatic Fractures - surgery
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2007.11.007

Summary Introduction We conducted semi-closed reduction of isolated tripod fractures of the zygoma through only a brow incision under intraoperative assessment with ultrasonography. Methods Twenty-three patients with unilateral, non-comminuted tripod fractures of zygoma were selected for application of this method at Tokyo Women's Medical University and Tokyo Metropolitan Hiroo General Hospital between April 2002 and April 2006. Patients with orbital floor blowout fractures were excluded. A skin incision was made only at the lateral brow region and the reduction was performed by inserting an elevator beneath the zygomatic arch. The bone alignment was intraoperatively assessed by ultrasonography. When the reduction was accurate, the frontozygomatic suture was immobilised with a mini-plate under direct visualisation and transmaler Kirshner wire fixation was performed. The accuracy of the reduction and postoperative movement were evaluated by computed tomography (CT) scans taken at 1 and 6 months. In five cases, the DICOM (Digital Imaging and Communication in Medicine) data from the CT were analysed with 3D imaging software (V-works, CyberMed Co., Korea). Results In all cases, accurate reduction was obtained. The analysis of the 3D imaging data revealed that postoperative movement of bone fragment was minimal. Conclusions When the accurate reduction was obtained under intraoperative assessment, the semi-closed reduction and one-plate fixation with transmaler Kirshner wire is enough to treat the simple tripod fractures of zygoma. This method is minimally invasive and takes less operative time.