TREATMENT

OF

1)EPRESSFD

FR-A(TURES

OF

THE

ZYGO-

MATIC
BY

(MALAR)
ROBERT F.

BONE
PATTERSON,

AND
M.D.,

THE

ZYGOMATIC
TENNESSEE

ARCH

KNOXVILLE,

1)epressed

fractures es)ecially hard

of

the treat

zygomatic

arch

often

present

difficult

l)moblems
\i(lua-ls
Ilolie

if reduced
are the difficulty
SOflie
,

successfully
to of grasping
l)ecause

wit-bout
successfully,

scar

formation.
owing to the

Fleshy
depth

mdiof the

a-nd

it with
is so ordinarily niustgrope

ami imistrumemit
much soft humidly, suggested. tissue and If

such
imi the usually treated

as the
bite by

towel
that opeii

(lii)
will fully,

used
not when to

I)y
reach

there ( )ne

it

the using

bomie. instruments

unsuccess-

operation,

an unsightly
the patient. The

scmim results,
treating

which
CaSes

is hemicefort-li
15 enhanced

a source
by the fact

of niortithat transmitted as involved great

ficat-iomi

force
the along
(leSiIed,

difficulty of is often necessary

of a triangle, the
to

these

to pull
much axis of

the
of the the

bone
force

outward.
is dissipated instead illustrate

Since
by of the

the
being

pull

is against

apex

longitudinal
effect

fragments follow

transversely,

the
case nieans

mediictioii.
1el)O1ts

The aiid

four

which of ieduction.

problems

a successful
CASE

1.
The

December wrestler.

5, 1934,

A. B. L., a mimale, aged timirty, wimile acting as referee in a wrestling match on was struck over time left zygommmatic arch with time naked fist of an angry
point of time blow landed squarely in time nmiddle of tile right arch, driving

FiG. Case
Vol..
XVII, NO. 4. O(TOiiI1(

I zvgoma before redu(tion. 1069

Fracture
1935

of right-

1070

H.

F.

PATTERSON

FIG.

2 reductioim. a greenstick fracture with time fragments

Case

1.

After

it inward

almost

to

time

skull

and

producing

lying

of about 30 degrees. A marked depression in the face resulted. Time patient experienced difficulty in moving the mandible, especially forward. It was evident that the soft tissues were being pressed against the coronoid process of the mandible. Being a man of fine appearance, the patient naturally recoiled from an open operation. The fact that his face was full added to the difficulty of closed reduction. The bone was restored to normal position in the following manner : A Straude-Moore straight tenaculum, five and three-quarters inches in length, with a Collins slip lock, was used. This instrument has a large curve or grasping space. The halves were disengaged, and one point was inserted straight through the skin and soft tissues just above where the zygomatic arch normally lies. In selecting the point of introduction, allowance was made for the great depth to be traversed to reach the bone. Time tenaculum was pushed inward and downward in the line of its curve until it struck the zygomatic process. It was engaged behind the bone and the handle elevated. The other half of the instrument was then introduced in a similar manner below the bone, the point passing inward and upward until it also caught behind the bone. With considerable difficulty, the handles were eventually brought into position and locked. This provided a powerful grip on the process at the site of the fracture. The instrument could not slip, being held in place by the soft tissues.
After the author had guardedly exerted his entire strength, a snap occurred
from

at an angle

and

the

bone
tion in

sprang
moving

Immediately

normal position. The upon awaking, the patient expressed the mandible.

back

into

depression complete

disappeared relief from

the

the binding

face. sensa-

CASE 2. S. H., football in the fall floor and rim of the process of the frontal In this case, one border of the orbit

a male, aged twenty, was struck on the left malar bone while playing of 1933. The blow depressed the entire bone, including the outer orbit. It carried inward also the anterior portion of the zygomatic bone. tooth of the Straude-Moore tenaculum was caught over the anterior while the other tooth pierced the muscles of the face beneath the
THE JOURNAL OF BONE AND JOINT SURGERY

DEPRESSED

FRACTURES

OF

THE

ZYGOMATIC

BONE

1071

immalam blomie. St mo1mg (lilt \m11h t iaet on sas ice pick was t hirust i)eimeat im time (Inter eimoh
i)OIme
stlllet

iim:mihe.
(If macaims,

Aim
time

t lie immalar

to mIles

assist eie

iim time raise(1 overcllnme.

elevation.

liv

this

tom simeim aim extent

t hat

t lie (hef(mrnm-

ity CASE

litrgelv

NI. 1. C.,
(ieimerai hospital t lie face it
(If

a miide,
on

was
i\Iay

it(hIiIlttC(l
1, 1935. struck

t I) time

I\Imoxvihle (laY leftlIlesseol

Oim oti

time time (he-

of

it(hlIiiS5i(IIl, (If

put iemmt had Ii a fist

lmeen

side

his

, )r(Iduciimg
greatly

a mmiaiked

apearaimce

Aim x-ray zygonma

(Jim Stra(m(le-\Ioore

t lie left cheek boime. exanmiimati(nm Simo\ve(h a fracture t Ime zygonmat ic arch

of t lie left (Iel)ressed. of a

aroun(l

vitii

-Itoniargin

2, 1935,
(If time

uimmier

aimaest

hmeSiIm, oime-hmalf passed zygoimmatic

teimaculurmi (lepressed time

imer.

time time
time
(Ifl

superior other
tVO time

arch,
aiuh

half halves

l)asse(i fast-ermed

itIiIIl1i(h
t(Iget

iimferior

nmargiim,

By

aim Outwar(h
WitS

pull
to

iimst-ruimmeimt

imorimmil
*

posit

, t lie zvg(Inmat ic arch iolm , restoring t ime coiitotmi

I ime Ort hopae(lic 4. Service

raise(h

its

FI(;.

3
I emma(Straude-

of

t ime face. .Jarreil

PelmIl.

lronm

of Dr. age(l

At- left-, veterimmarian mihimmim; at, right, Ioore tenmactmltmm.

CASE struck

H.
cimeek

L.

N.,
against

nmale,

tweimty-oime, while It
\(5

imis rigimt

time side
nmalar

of a pool latter
mmmaiar

(hiving
was

on

June

22, fronm

1935.

A (he-

pressed arcim
outer

fracture at its junction etimem

of time

of time rigimt with

zygotnatic

i)omme resulted. Time

of the

severed

time zygonmatic
around

time arcim.
process

not-

(Iel)ressed.

1n(ler
en(I

aimaesthiesia, time imooks (beneath rockimmg

bonme to

a Straimde-i\-Ioore of time tenaculummm. 1)oIme) to

imornmai

tenmcuiunm
l)olme.

was
Tractioim

introduce(l

the
oimly
timen

was the

fruitless
process.

aimd
was

st-raighteimed immserted great froni force

to elevate

out below an(l by

Time at break
position.

veterinarian
witim

tenaculum time author

sides of

time immalar time inst-rumetmt

practically

its julmctioll up

By using
was
time face

ilmmj)actiorm,
Time two

finally
now

able
appear

time

svnmmmmetrical.

If reduction
ill zygoiiiatic

catmnot
fractures,

l)e the

secure(l powerful

with

the

Straude-\Ioore t-enacululn

imistrumnetit
is forced in

veterinarian

above

the
from (JftPn
KEY,

arch

and

hooked
as

around
described

the
in

bone. fractures
Case 4.

Leverage this
The

against instrument
ordinary ice

the

skull
pick is

can
duced also
1.

be exerted
UsefUl
JOHN

if necessary.
beneath, in reduction.
AND

Imi malar

is intro-

ALBERT,

CONWELL,

I-I.
Time

EAaLE:

rime Maimmgenmment
V. Mosily Commmpaimy,

of

Fractures,

Dislocations,

atmd

Sprains.

St.

Icniis,

C.

1934.

VOL.

XVII.

NO.

4.

OCTOBER

1935