Ultrasound-Guided Closed Reduction of Zygomatic Arch Fractures: Clinical Utility According to Fracture Type

Closed reduction of zygomatic arch fractures is routinely performed without direct visualization, relying on palpation and clinical inspection to assess reduction adequacy. Intraoperative ultrasound has been shown to improve reduction outcomes, particularly in complex fracture patterns. However, no study has systematically evaluated the role of ultrasound in different zygomatic arch fracture types. The authors present a consecutive series of 11 patients with zygomatic arch fractures managed with ultrasound-guided closed reduction at a tertiary center between November 2024 and April 2026. Fractures were classified according to the system proposed by Özyazgan and colleagues. Reduction was carried out using a Gillies, Keen, or combined approach under real-time intraoperative ultrasound using high-frequency linear probes. Five patients had isolated arch fractures (type I) and 6 had combined fractures (type II). Rereduction of the arch was unnecessary in any isolated fracture. In contrast, 3 of 6 patients with combined fractures (50%) showed persistent arch displacement on ultrasound after internal fixation of adjacent buttresses, prompting intraoperative rereduction. Postoperative ultrasound follow-up (mean 17.8 d) confirmed maintained reduction (0 mm residual depression) in 63.6% and residual depression of 2 mm or <90.9%. No neurovascular complications or reoperations occurred. Intraoperative ultrasound proves most valuable in combined zygomatic arch fractures, where fixation of adjacent buttresses may secondarily displace a previously reduced arch.