Optimizing closed reduction of nasal and zygomatic arch fractures with a mobile fluoroscan.
BACKGROUND
Although closed reductions of nasal fractures and zygomatic arch fractures are considered minor procedures, improper reductions are not uncommon. Objectively evaluating reduction adequacy with imaging assistance during surgery is crucial. The authors used mobile Fluoroscan intraoperatively to assess the adequacy of closed reduction for nasal fractures and zygomatic arch fractures.


METHODS
Patients with nasal fractures or zygomatic arch fractures who underwent surgery between 2000 and 2004 were enrolled. Results were reviewed according to postoperative photographs and radiography. Scoring systems were designed for objective assessment, with higher scores representing better outcome.


RESULTS
One hundred eight patients with nasal fractures and 36 patients with zygomatic arch fractures were enrolled. Fifty-three patients underwent closed reduction of the nasal fracture with fluoroscopic assistance (group NF) and 55 patients underwent closed reduction without fluoroscopic assistance (group N). The mean scores for the fluoroscopic assistance group was 2.96 for radiography and 2.91 for photography, compared with 2.58 for radiography and 2.67 for photography for the group without fluoroscopic assistance. The difference was significant for radiography (p = 0.001) but not for photography (p = 0.068). Of the patients with zygomatic arch fractures, 16 were repaired with fluoroscopic assistance (group ZF) and 20 were repaired without fluoroscopic assistance (group Z). The average score for group ZF was 2.81 for radiography and 2.94 for photography, compared with 2.45 for radiography and 2.6 for photography in group Z. There were significantly higher scores for group ZF for both radiography and photography.


CONCLUSIONS
The mobile Fluoroscan provides direct visualization of the fracture site and instruments and improves the outcomes of closed reduction.
Chen
Ruei-Feng
RF
Taoyuan, Taiwan From the Division of Trauma Plastic Surgery, Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine.
Chen
Chien-Tzung
CT
Hao Chen
Chih
C
Liao
Han-Tsung
HT
Chen
Yu-Ray
YR
D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation* / Q000379:methods; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D007430:Intraoperative Care / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009295:Nasal Bone / Q000293:injuries*; D012189:Retrospective Studies; D018570:Risk Assessment; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult; D015051:Zygomatic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*