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 sinus
3. 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 opening

Signs and symptoms

o Facial bruising/swelling
o Flattened malar eminence

o Loss of facial sensation below orbit (infraorbital nerve

involvement)
o Trismus / altered mastication
o 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.