Is there still a role for traditional methods in the management of fractures of the zygomatic complex?

With the introduction of low-profile mini-plating systems, a trend has developed towards open reduction and rigid internal fixation (ORIF) of fractures of the cranio-facial skeleton. The current policy for management of zygomatic fractures in our unit is to attempt primary reduction by traditional methods, and proceed to ORIF in the event of unsatisfactory fracture stability or alignment. Over a one-year period, 109 patients underwent surgical correction of fractures of the zygomatic complex. Standard Gilles' elevation was performed in 71 cases, percutaneous elevation in three cases, and ORIF was performed in 35 cases. Mean follow-up was 190 days. One case of persistent infraorbital step and three cases of residual malar flattening were documented in patients who underwent Gilles or percutaneous elevation. Morbidity associated with ORIF was minimal. We conclude that while ORIF of zygomatic fractures may offer better results than traditional methods in the management of complex fractures, traditional methods still have a role to play in less complex fractures.