Does C-Arm Guidance Improve Reduction of Zygomatic Arch Fractures?—A Randomized Controlled Trial

Abstract

Traditionally, in the assessment of the reduction of zygomatic arch fractures, the surgeon uses subjective measures such as palpation of a bony step deformity, the anecdotal "pop" sounds, and visual confirmation of symmetry. In the present study, we sought to objectively assess the accuracy of reduction and improvement in form and function after C-arm-guided reduction of isolated zygomatic arch fractures (IZAFs) and to compare these results with those obtained conventionally. A prospective, randomization of patients scheduled for surgical closed reduction of IZAF was performed. The test group underwent C-arm-guided reduction of the fracture until the arch contour was re-established and visualized on fluoroscopic images. In the control group, palpation, auditory cues, and visualization of symmetry determined the adequacy of the reduction. The patients and evaluator were both unaware of the treatment technique used. The primary outcome measures were the maximum interincisal distance (IID), standardized measurements on computed tomography (CT), and measures of symmetry on facial photographs. Variables such as intragroup differences and patient-evaluator agreement were also studied. The data were analyzed using SPSS software, version21. The study sample consisted of 20 patients (10 each in the test and control groups). Significant improvement in facial symmetry was observed in all 20 patients (P<.001) from preoperatively to 30days postoperatively. The CT measurements confirmed acceptable symmetry, with insignificant differences between the 2 groups (C-arm group, P<.001; vs control group, P=.004 for intragroup improvement in symmetry). The IID had improved significantly (P<.001) at the end of follow-up in both groups. Although significantly superior outcomes were not inferred in the symmetry-related and CT measurements, C-arm-guided reduction provided an opportunity to instantaneously confirm the accuracy of bony reduction. Thus, the need for postoperative imaging and secondary surgery can be overcome, enabling even inexperienced surgeons to attain precise and reproducible results.