Frontal bone fractures: new technique of closed reduction

Abstract

Fractures of the nasofrontal orbital complex account for 5% of all facial fractures. Mean hospitalization is usually longer than for other types of facial lesions, independent of the trauma responsible (road accidents, sport, falls, firearm wounds, and so on). The choice of treatment, usually dictated by the site and extent of the damage, is important because inadequate treatment may lead to immediate or subsequent complications. A conservative surgical technique for use in the treatment of non-comminuted frontal lesions is described, which consists of the closed reduction of the depressed fragments by means of a small percutaneous approach. Before surgery, a computed tomography scan is carried out with 2-mm slices both in the axial and coronal projections, mandatory to evaluate the orbital roof and frontal region. The peripheral limits of the frontal region fracture are marked on the skin, a punctiform incision made in the area of maximum depression, and a calibrated drill inserted. Two small holes are created in the center of the depressed fragment and two pins screwed in, both of a length to allow the surgeon an easy reduction maneuver. A radiographic evaluation is then performed to check the correct alignment of the previously depressed fragment, the two percutaneous pins removed, and two sutures applied, if necessary. This technique avoids the scarring often observed after the open reduction technique and, in selected cases, treatment may be carried out in neuroleptanalgesia reducing operating as well as hospitalization times and healthcare costs.