The Tripod Fracture

The tripod fracture (officially known as the zygomaticomaxillary complex fracture, and sometimes called a malar fracture) is the most common one seen after trauma.*Fundamentally, the zygoma is separated from the rest of the face in a tripod fracture. There are three components to this fracture.1. The first is a fracture through the zygomatic arch .2. Next, the fracture extends across the floor of the orbit and includes the maxillary sinus3. Finally, the fracture includes the lateral orbital rim and wall .

Most common midface # (40%) Usually from direct blow to zygoma body Usually separation of all 3 attachments to face Fractures of any of : Zygomaticofrontal suture Zygomaticomaxillary Infraorbital rim Lat wall of maxillary sinus Central part of orbital floor Features: Cheek/periorbital oedema/tenderness, infraorbital rim step, infraorbital n. paraesthesia, diplopia, subcut emphysema, test mandibular openingSigns and symptoms Facial bruising/swelling Flattened malar eminence Loss of facial sensation below orbit (infraorbital nerve involvement) Trismus / altered mastication Diplopia +/- ophthalmoplegia

Extraocular muscles may become trapped in the fracture line, leading to diplopia. It is very important to do a good eye exam to try to detect entrapment. The infraorbital nerve also passes through the orbital floor and may be injured, leading to numbness along the lower eyelid and upper lip. Nondisplaced fractures are treated symptomatically and reevaluated after a week or so to see if surgery would be beneficial. Displaced or symptomatic fractures require early open reduction. Inv: Facial/orbital CT Mx: Analgesia, dont blow nose, amoxicillin prophylaxis, non-displaced or minimally displaced fractures may be treated conservatively. Fractures with displacement require surgery consisting of fracture reduction with application of plates and screws to keep the bone fragments in place. Gillie's approach is used for depressed zygomatic fracture.