Indications for ORIF in Zygomaticomaxillary Complex Fractures
Open reduction and internal fixation (ORIF) is indicated for ZMC fractures with significant displacement of the malar eminence, particularly when severe medial-lateral displacement is present, when multiple dimensions show displacement, or when there is comminution requiring stable fixation. 1
Primary Indications Based on Displacement Severity
Severe displacement in one or more dimensions (medial-lateral, superior-inferior, or anterior-posterior) is the strongest predictor requiring ORIF, with medial-lateral (x-axis) displacement being most strongly correlated with need for surgical intervention 1
Patients with high fracture scores (3,4, or 5 based on severity of displacement in each dimension) have significantly higher rates of requiring ORIF compared to those with low scores (0,1, or 2) 1
Greater cumulative malar eminence displacement measured in three-dimensional space indicates need for ORIF 1
Anatomic and Structural Indications
Displacement at the zygomaticosphenoid suture is a critical indicator, as this reflects orbital volume changes and asymmetry that require surgical correction 2
Significant comminution of the ZMC requires ORIF for adequate stabilization, as simple closed reduction will not maintain anatomic position 2
Fractures involving the infraorbital nerve (V2) with clinical deficits warrant surgical exploration and fixation 2, 3
Complex fractures of the zygomatic body combined with zygomaticomaxillary buttress fractures and inferior orbital rim involvement require ORIF to prevent malunion or nonunion 4
Orbital Floor Considerations
- Patients requiring orbital floor repair typically have greater overall displacement (Euclidean distance) of the malar eminence, though this is less strongly associated with displacement measures than ZMC repair alone 1
Common Pitfalls to Avoid
Do not rely on plain radiography alone, as it misses approximately 12% of maxillofacial fractures; CT maxillofacial without contrast is essential for surgical planning 2
Incomplete reduction identified on intraoperative radiologic examination requires additional fixation points or approaches to prevent postoperative malunion 4
Underestimating the degree of displacement in multiple dimensions can lead to inadequate treatment planning; three-dimensional CT reconstructions are critical for accurate assessment 2, 1