Transcutaneous reduction and external fixation for the treatment of noncomminuted zygoma fractures

Percutaneous Reduction of Isolated Zygomatic Arch Fractures: A 5-Year Experience

PURPOSE

We evaluated the outcomes and differences in surgical time and hospitalization length for patients with an isolated zygomatic arch (ZA) fracture treated by percutaneous wire reduction with external fixation.

PATIENTS AND METHODS

We designed and developed a retrospective study of patients with isolated ZA fractures treated from 2014 to 2019. The predictor variable was the operative treatment, represented by percutaneous reduction with external fixation. The primary outcome variables were the surgical time and hospitalization length. Other variables, including functional and esthetic results (evaluated by clinical and radiologic assessments) and the rate of immediate and delayed complications during a 6-month minimum follow-up period, were considered. Descriptive statistics were computed and compared with the international reported data.

RESULTS

A total of 15 patients met specific inclusion and exclusion criteria. The 15 fractures were grouped using the classification reported by Kim et al as type 1A (n = 9) and type 1B (n = 6). No significant differences were found between the 2 groups, except for the fracture type. The operative treatment was performed with the patient under general anesthesia (n = 12) or local anesthesia with sedation (n = 3). Only 1 patient developed a complication (early hematoma). No other cases of early or delayed complications were reported. Two patients required a traditional surgical operation with the Gilles approach. The average hospitalization length and surgical time were 0.8 night and 18.4 minutes for the type 1A group and 0.7 night and 19.0 minutes for the type 1B group, respectively. Optimal esthetic and functional outcomes were obtained for all 15 patients.

CONCLUSIONS

The results of the present study suggest that optimal esthetic and functional results can be obtained, minimizing the effect on soft tissues and patient discomfort, with a short surgical time and low rate of complications.

Kirschner Wire Fixation for the Treatment of Comminuted Zygomatic Fractures

Background

The Kirschner wire (K-wire) technique allows stable fixation of bone fragments without periosteal dissection, which often lead to bone segment scattering and loss. The authors used the K-wire fixation to simplify the treatment of laborious comminuted zygomatic bone fracture and report outcomes following the operation.

Methods

A single-institution retrospective review was performed for all patients with comminuted zygomatic bone fractures between January 2010 and December 2013. In each patient, the zygoma was reduced and fixed with K-wire, which was drilled from the cheek bone and into the contralateral nasal cavity. For severely displaced fractures, the zygomaticofrontal suture was first fixated with a microplate and the K-wire was used to increase the stability of fixation. Each wire was removed approximately 4 weeks after surgery. Surgical outcomes were evaluated for malar eminence, cheek symmetry, Kwire site scar, and complications (based on a 4-point scale from 0 to 3, where 0 point is 'poor' and 3 points is 'excellent').

Results

The review identified 25 patients meeting inclusion criteria (21 men and 4 women). The mean age was 52 years (range, 15-73 years). The mean follow up duration was 6.2 months. The mean operation time was 21 minutes for K-wire alone (n=7) and 52 minutes for K-wire and plate fixation (n=18). Patients who had received K-wire only fixation had severe underlying diseases or accompanying injuries. The mean postoperative evaluation scores were 2.8 for malar contour and 2.7 for K-wire site scars. The mean patient satisfaction was 2.7. There was one case of inflammation due to the K-wire.

Conclusion

The use of K-wire technique was associated with high patient satisfaction in our review. K-wire fixation technique is useful in patient who require reduction of zygomatic bone fractures in a short operating time.

First percutaneous reduction and next external suspension with Steinmann pin and Kirschner wire of isolated zygomatic fractures

We have introduced a less invasive, simple, and effective method for zygomatic fractures using percutaneous reduction with a Steinmann pin (S-pin) and temporary external suspension with a Kirschner wire (K-wire).For 2 years, 51 patients underwent first percutaneous reductions and then fixations, which is a method that we developed. After the S-pin no. 1 was percutaneously inserted at the most prominent point of the zygoma, closed reduction was first attempted using lever movement and temporary external suspension with a K-wire. If required, 1-site rigid fixation was performed on the zygomaticomaxillary buttresses via gingivobuccal incisions. Only 13 patients received K-wire suspensions and 38 patients received K-wire suspensions and lateral buttress fixations. We evaluated the postoperative result in 4 aspects (flattening, symmetry, scar, and paresthesia) using the 4-point visual analog score after at least 6 months.The mean maintenance period of the S-pin and K-wire was 12.3 days, and the mean operation time was 33 minutes. No serious complications, such as infections or external wire instability, were observed. Excellent or good results were achieved in more than 95% of patients in all 4 aspects mentioned.We believe that our method, which is the first percutaneous reduction using S-pin and temporary external suspensions with a K-wire with or without a lateral buttress rigid fixation, is a simple and effective method for noncomminuted zygomatic fractures.

Gillies elevation and percutaneous Kirschner wire fixation in the treatment of simple zygoma fractures: long-term quantitative outcomes

BACKGROUND

The objective of zygoma fracture repair is to restore preinjury function and appearance. The optimal surgical technique represents a balance between accurate fracture reduction and soft-tissue morbidity.

METHODS

Fifty patients were eligible for review after treatment for isolated simple zygoma fractures using a combination of Gillies elevation and percutaneous Kirschner wire fixation between 1992 and 2003. Fourteen patients were available for examination at a mean follow-up of 8.7 years. Quantifiable parameters, including orbitozygomatic complex position, ocular globe projection, and infraorbital nerve function, were measured. All patients underwent qualitative assessment by independent, blinded observers. Negative soft-tissue sequelae were recorded.

RESULTS

The mean differences between injured and uninjured sides of the face for malar eminence projection, height, and lateral position were 2.5, 2.7, and 2.3 mm, respectively. The mean difference in ocular globe projection was 1.23 mm. When these results were compared with those previously published for open reduction and internal fixation, no statistically significant difference was noted. The qualitative observers were able to identify the affected side 12 percent of the time. Other than a small punctate scar noted in one patient at the Kirschner wire insertion site, no other negative cutaneous or eyelid sequelae were noted.

CONCLUSIONS

This study objectively shows that Gillies elevation combined with percutaneous Kirschner wire fixation provides facial contour restoration that is not significantly different from that of open reduction and internal fixation, with less soft-tissue morbidity. The technique is safe, easy to learn, and easy to perform, and should be considered in cases of isolated simple zygoma fractures.

Treatment of Noncomminuted Zygomatic Fractures With Percutaneous Screw Reduction and Fixation

The standard treatment modality of zygomatic fractures is open reduction and rigid fixation of the fractured segments. Although most of the zygomatic fractures deserve this attentive surgical manipulation to prevent late residual asymmetry, minimally depressed noncomminuted zygomatic fractures can be reduced and fixed percutaneously. Percutaneous intervention causes minimal scarring and morbidity than open techniques and it is possible to align fragments precisely by using high-quality three-dimensional computed tomography (3-D CT) imaging. Six patients with noncomminuted fractures of the zygomaticomaxillary skeleton were evaluated with plain radiographs of facial bones, axial, coronal and 3-D CT. Reduction of the displaced bone segments were achieved by traction of percutaneously applied screw. Either reduced segments were not fixated at all or one of the two new fixation techniques, described in detail in the article, were used for stabilization of reduced segments. In all patients, accurate reduction was obtained. None of the patients showed any recurrent displacement or infection during the follow-up period of six months. The screws were removed in the clinical settings without difficulty. Although percutaneous reduction and external fixation of noncomminuted zygomatic fractures has limited indications, it has its own advantages over open techniques. This method is a less invasive technique and can be performed without any problem in selected cases. Our technique is not suitable for complex zygomatic and periorbital fractures.