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Tripod Fracture

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  • 1.  52yo F presents after MVC rollover. Pt was restrained but no airbags in vehicle.+LOC. C/O headache and facial pain. Double vision. Numbness below eye.  T 98.2 HR 80 BP 160/90 RR 18 PO2 100%  Neuro: AAOx3  HEENT: PERRLA, EOMI, +Trismus, +lateral cheek flattening, decreased sensation below orbit
  • 2. Arrowheads: Inf/Lat Orbit Wall fx 1.Anterior Zygoma Fx Arrows:air fluid level in maxillary sinus 3.Medial Maxillary Sinus Fx 2.Posterior Zygoma Fx
  • 3.  Displaced  Minimal/Non-Displaced Admission Normal Optho Exam Internal Fixation Soft Diet Analgesics OMFS f/u with elective repair
  • 4. 3 Fracture Components: Zygomatic Arch Lateral Orbit Wall Inferior Orbital Floor Usually need CT Temporal bone thickness obscures subtle findings Thorough Eye Exam Important
  • 5. Orbital emyphsema from maxillary sinus communication Severe displacement
  • 6.  http://www.rad.washington.edu/academics/academic- sections/msk/teaching-materials/online-musculoskeletal-radiologybook/facial-and-mandibular-fractures/?searchterm=tripod%20fracture Mettler: Essentials of Radiology, 2nd ed. Facial Trauma Chapter Pascoto, A. Imaging in Orbital Fractures. MedScape alexandriaradiology.com Tollefson, T. Zygomaticomaxillary complex fractures. MedScape  Tintanelli’s Emergency Medicine: A Comprehensive Study Guide. Chapter 257 Maxillofacial Trauma