Fixation at the Inferior Orbital Rim in Medially Rotated Zygomatic Complex Fractures

Zygomatic complex fractures are quadri-pod fractures because of the involvement of the zygomaticotemporal, zygomaticomaxillary, zygomaticofrontal, and zygomaticosphenoid junctions. The need to address one or more fixation points of these four articulations mainly depends on the degree of displacement. In this article, the authors present a series of medially rotated zygomatic complex fractures to demonstrate that one-point fixation at the inferior orbital rim (IOR) is sufficient in most cases. METHODS: This is a retrospective study of all medially rotated zygomatic complex fractures treated by the authors over the last 4 years. RESULTS: The patients were six men with a mean age of 41 years. All patients sustained medially rotated zygomatic complex fractures. Three patients had symptomatic orbital floor defects. One patient had concurrent displaced superior orbital rim fracture. Surgery was done using the transconjunctival approach. A titanium mesh was used to fix the IOR. For orbital floor reconstruction, the same titanium mesh was extended into the floor to cover the defect. The patient with concurrent superior orbital rim fracture required a second point of fixation at the lateral orbital rim. CONCLUSIONS: Single-point of fixation at the IOR is sufficient in most medially rotated zygomatic complex fractures as long as there is minimal displacement at other fracture points. Some of these patients may have symptomatic orbital floor defects. Simultaneous fixation of the IOR and orbital floor reconstruction may be done via a transconjunctival approach.