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J Gandhara Med Dent Sci
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ORIGINAL ARTICLE
:
:
THE RETROSPECTIVE COMPARISON OF CLOSED AND OPEN REDUCTION IN THE
MANAGEMENT OF ZYGOMATIC COMPLEX FRACTURE
Sehrish Liaqat
1
, Anoosh Alishba
2
, Tehreem Malik
3
, Omaima Naeem
4
, Fazal Amin
5
, Abid Hussain Kanju
6
ABSTRACT
OBJECTIVES
This study aimed to determine the management and clinical outcomes of
zygomaticomaxillary fractures (ZMC).
METHODOLOGY
This retrospective study was conducted from January 2023 to December 2024
in the Department of Oral & Maxillofacial Surgery at Nishtar Institute of
Dentistry, Multan. A total of 90 patients, including both genders, were
selected. The diagnosis was made on the CT scan of the face. The data was
collected from the hospital records. SPSS version 23.0 was used for data
analysis. Chi-square statistics were used to assess the association between
the treatment approach and the incidence of ZMC fractures, as well as the
side of ZMC fractures, with a level of significance set at p < 0.05.
RESULTS:The mean age in this study was 35.54± 15.35 years. Males were
70(77.78%) and females were 20(22.22%). The dominant age group was 21-
35 years, accounting for 32 (35.56%). The most common cause was RTA
41(45.56%) followed by fall 22(24.4%). Most fractures (64.4%) were
managed through open reduction. Subconjunctival ecchymosis (55, 61.11%)
was the most common clinical finding seen, followed by tenderness on the
zygomatic buttress. Chi-square statistics revealed a statistically significant
association (p < 0.001) between the treatment approach and the incidence of
ZMC fractures and the side of ZMC fractures. Logistic regression identified
closed reduction (AOR: 3.72, 95% CI: 1.21-11.47, p-value: 0.022) as a
predictor of patients' aesthetic dissatisfaction.
CONCLUSION:The findings of this study concluded that the role of open
reduction in displaced and comminuted fractures of the ZMC is in achieving
superior aesthetic and functional outcomes.
KEYWORDS: Facial Injuries, Zygomatic fracture, Etiology, Open Fracture
Reduction, Clinical Findings
How to cite this article
Liaqat S, Alishba A, Malik T, Naeem
O, Amin F, Kanju AH the Retrospective
Comparison of Closed and Open
Reduction in the Management of
Zygomatic Complex Fracture.J Gandhara
Med Dent Sci.2025;12(4):13-17. https://
oi.org/10.37762/jgmds.12-4.758
Date of Submission: 29-11-2024
Date Revised: 15-03-2025
Date Acceptance: 18-03-2025
1
Associate Professor, Department of Oral
and Maxillofacial Surgery, Nishtar
Institute of Dentistry Multan
2
Post graduate Resident, Department of
Oral and Maxillofacial Surgery Nishtar
Institute of Dentistry Multan
6
Assistant Professor, Department of Oral
and Maxillofacial Surgery, Nishtar
Institute of Dentistry Multan
Correspondence
5
Fazal Amin, Post graduate Resident,
Department of Oral and Maxillofacial
Surgery, Nishtar Institute of Dentistry
Multan
+92-333-9299137
drfazalamin@yahoo.com
3
Post graduate Resident, Department of
Oral and Maxillofacial Surgery Nishtar
Institute of Dentistry Multan
4
Post graduate Resident, Department of
Oral and Maxillofacial Surgery Nishtar
Institute of Dentistry Multan
INTRODUCTION
The human facial skeleton is a complex and delicate
structure, composed of multiple bones that provide both
functional and aesthetic support to vital structures such
as the eyes, nose, and mouth. Among the facial bones,
the zygomaticomaxillary complex (ZMC) plays a
pivotal role in maintaining midfacial integrity.
1,2
ZMC
fractures, also known as tripod or tetrapod fractures, are
among the most frequently encountered midfacial
fractures in maxillofacial trauma, often resulting from
high-energy impacts such as road traffic accidents,
physical assaults, sports injuries, and falls. Due to its
prominent anatomical location and structural
significance, the zygomatic bone is highly vulnerable to
trauma.
3
The zygomatic articulates with four adjacent
bones: the maxilla, frontal, sphenoid, and temporal
bones, which form a complex bony buttress that
contributes to the contours of the cheek, lateral wall,
and floor of the orbit and zygomatic arch.
4,5
The
incidence of ZMC fractures varies widely across
regions due to socio-demographic factors, cultural
practices, and trauma patterns. Studies have revealed
that ZMC fractures account for approximately 13 to
26% of all facial fractures, making them one of the
most commonly encountered injuries in maxillofacial
surgery.
6,7
The male-to-female ratio ranges from 3:1 to
5:1, indicating a higher involvement of males in
outdoor activities, interpersonal violence, and road
accidents. The age group most commonly affected is
between 20 and 40 years, often considered the most
active and productive period of life.
8
Patients presenting
with ZMC fractures have a variety of signs and
symptoms. The signs and symptoms of ZMC fractures
depend on the severity and direction of displacement.
The most common clinical features of ZMC fractures
consist of flattening of the malar prominence,
periorbital swelling and ecchymosis, subconjunctival
hemorrhage, diplopia, and limited ocular motility due to
orbital floor involvement, infraorbital hypoesthesia, and
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J Gandhara Med Dent Sci
October - December 2025
trismus if the zygomatic arch is involved.
9,10,11,12
The
subtle nature of some ZMC fractures may lead to
underdiagnosis, particularly in polytrauma patients or
those with concomitant head injuries. Therefore, a high
index of suspicion is warranted.
13
A thorough clinical
examination, complemented by imaging, is essential for
accurate diagnosis and planning of ZMC fracture
management. While plain radiographs have been
traditionally used, they often lack sensitivity in
detecting complex fractures or orbital involvement. In
computed tomography (CT) scans, the axial and coronal
views are considered the gold standard. The
management of ZMC fractures aims to restore
anatomical alignment, functional competence, and
facial aesthetics. The decision between conservative
and surgical intervention depends on the degree of
displacement, functional impairment, cosmetic
concerns, and associated injuries.
14,15,16,17
Despite the
substantial literature on ZMC fractures, there is a
persistent need for institutional audits and retrospective
analysis to identify trends in management and
outcomes. Patient demographics, variability in fracture
patterns, and treatment modalities are mandatory for a
localized approach in order to optimize protocols and
improve patient care.
This study aimed to evaluate the
clinical management approaches and postoperative
outcomes of patients diagnosed with ZMC fractures.
METHODOLOGY
This study was designed as a retrospective
observational analysis conducted at the Department of
Oral & Maxillofacial Surgery, Nishtar Institute of
Dentistry, Multan, over the period from January 2023 to
December 2024. Prior to data collection, ethical
approval (Ref 6684/NID) was obtained from the
Institutional Review Board of Nishtar Institute of
Dentistry, Multan. Due to the retrospective nature of the
study, patient consent was waived. Patients aged 18
years or older of any gender, with a Radiologically
confirmed diagnosis of ZMC fractures on CT scan, who
underwent either open, closed reduction, or observation
for fracture management, and had complete
preoperative and postoperative records, with a
minimum follow-up duration of 6 months, were
included in the study. Patients with incomplete or
missing clinical or radiographic records. Patients with
associated panfacial fractures or severe head injuries
obscuring ZMC fracture analysis, and Patients lost to
follow-up before 6 months post-treatment were
excluded from the study. Data were collected from the
electronic hospital database and surgical records using a
structured data collection proforma. The data collected
included demographic information, etiology of trauma,
fracture characteristics, radiological findings,
management approaches, type and number of fixation
devices, associated complications, and postoperative
follow-up data. All zygomatic complex fractures were
classified according to Zingg et al.
13
, as shown in
Figure 1.
Figure 1: Schematic illustration of fracture types. A: Type A1,
isolated zygomatic arch fracture. B: Type A2, isolated lateral
orbital wall fracture. C: Type A3, isolated infraorbital rim
fracture. D: Type B, tetrapod fracture. E: Type C, multifragment
zygoma lateral orbital complex fracture.
Strict inclusion and exclusion criteria, standardized data
extraction, data collection by two independent
investigators, radiographic evidence of bone continuity
and clinical recovery, and blinded statistical analysis
(open reduction vs closed reduction) were employed to
minimize the risk of bias in this study. The collected
data were analyzed using SPSS 23.0 version.
Descriptive statistics were obtained for demographic
data, fracture patterns, and treatment modalities. Chi-
square statistics for the association between treatment
approaches and incidence of ZMC fracture and side of
ZMC fracture. Multivariate logistic regression analysis
to identify predictors of unfavorable outcomes with
odds ratios and 95% confidence intervals reported. A p-
value of <0.05 was considered statistically significant.
RESULTS
A total of 90 patients were included in the study,
comprising 70 males (77.8%) and 20 females (22.2%),
indicating a male-to-female ratio of approximately
3.5:1. The mean age of the patients was 35.54±15.35
years. The majority of cases (48; 53.3%) were within
the 21-35 years age group, followed by the 36-50 years
age group (22; 24.4%). The age groups 18-20 and those
over 50 had a similar number of cases (10; 11.1%
each). The most frequent incision used was Gilles
temporal incision 70(77.78%) followed by lateral
eyebrow 52(57.78%), infra-orbital 39(45.34%),
subciliary 15(17.44%) and lateral canthopexy
03(3.48%). Existing laceration was used in 06(6.97%)
cases. In 13 (15.12%) cases, one-point fixation was
used, while in 28 (32.55%) cases, two-point fixation
was used, and in 17 (19.76%) cases, three-point fixation
was used. The most commonly involved area for one-
point fixation was the zygomatic buttress (11, 12.22%),
followed by the FZ (02, 2.32%) and the infraorbital (01,
1.16%). The clinical findings seen in these patients
were subconjunctival ecchymosis 55(61.11%),
tenderness on buttress 39(45.34%), flattening of cheek
The Retrospective Comparison of Closed and Open Reduction
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October - December 2025
37(43.02%), infra-orbital rim deformity 31(36.04%),
paresthesia 24(27.90%), restricted mouth opening
15(17.44%), malocclusion 13(15.11%), head injury
08(9.30%), diplopia 07(8.14%) and temporary
blindness 02(2.33%). Chi-square statistics revealed a
statistically significant association (p < 0.001) between
treatment approaches and the side of the ZMC fracture,
as well as the incidence of ZMC fractures involved, as
shown respectively. Complications were noted in 18
patients (20%). The distribution of complications in
different treatment approach groups is given in the
Table. Infraorbital paresthesia was the most common
complication and was mostly transient, resolving within
3 months in the majority of cases. Satisfactory aesthetic
outcomes were observed in 82 patients (91.1%). Mild
malar asymmetry in 6 patients (6.7%) in the closed
reduction group. Moderate asymmetry requiring
revision in 2 patients (2.2%), both of whom were
initially managed conservatively. Logistic regression
analysis for patient dissatisfaction revealed that closed
reduction was significantly associated with aesthetic
dissatisfaction (Adjusted Odds Ratio: 3.72, 95%
Confidence Interval: 1.21-11.47, p-value: 0.022).
Table 1: Etiology, Side Distribution, Incidence, and Treatment
Approaches of ZMC Fractures (n = 90)
Variable Category Frequency(n) %age
Etiology Road Traffic
Accidents
41 45.6
Falls 22 24.4
Sports Injury 15 16.7
Violence 06 6.7
Animal Injury 06 6.7
Side
Distribution
Right side 59 65.6
Left side 25 27.8
Bilateral 06 6.7
Incidence of
ZMC
Fracture
Isolated ZMC
Fracture
41 45.6
ZMC is associated
with injuries
22 24.4
Isolated Zygomatic
Arch
16 17.8
Isolated Infraorbital
Fracture
11 12.2
Treatment
Approach
Open Reduction 58 64.4
Closed Reduction 23 25.6
No Surgery 09 10.0
Table 2: Frequency of ZMC with Associated Injuries (n = 22)
Associated Injury
ZMC only
ZMC & Le Fort fracture
ZMC & Mandible fracture
ZMC & Nasal fracture
ZMC & Orbital floor repair
ZMC & Orbital floor exploration
Frequency (n) %age
68 75.6
10 11.1
04 4.4
04 4.4
03 3.3
01 1.1
Table 3: Association of Side of ZMC Fracture with Treatment
Approach
Variable Chi-Square (χ²) p-value
Side of fracture × Treatment 48.067 0.000
Treatment × Incidence 42.467 0.000
Table 4: Association of Treatment Approach with Incidence
of ZMC Fracture
Variable Chi-Square (χ²) P-value
Treatment × Incidence of
fracture
22.978 0.000
Table 5: Postoperative Complications in ZMC
Fracture Management
Complication Frequency
(n, %)
ORIF
Group
Closed
Reduction
Group
Infra-orbital nerve
paresthesia
08 (8.9%) 05 03
Postoperative
infection
04 (4.4%) 03 01
Malar depression 03 (3.3%) 01 02
Diplopia (transient) 02 (2.2%) 01 01
Plate exposure 01 (1.1%) 01 00
DISCUSSION
This retrospective analysis of 90 patients with ZMC
fractures provides meaningful insights into the
demographic trends, etiological factors, surgical
intervention, and complications associated with the
management of these injuries. The demographic
analysis of this study demonstrated that the
predominant age group seen was the third decade. This
study is consistent with the study done by Menon et
al.14 Males were found to be more dominant than
females in this study. Menon et al.
14
in their study also
revealed that the predominant gender was male, which
supports this study. Kambalimath demonstrated that
males were frequently involved than females.
15
These
studies support our study. The reason could be that
males are more involved in outdoor activities than
females. The findings of this study revealed that RTA
was the most common cause of ZMC fracture, which
aligns with a study by Patil et al.
16
Urbanization and not
wearing a protective helmet may be contributing
factors. Falls were the second most dominant cause of
ZMC fractures in our study, which is inconsistent with
Kambalimath et al.
15
, who reported that assault was the
second most predominant cause of ZMC fractures.
Bogusiak etal.
2
in their study proposed that assault was
the second most common cause of ZMC fracture, which
opposes this study. The etiology varies from country to
country and even within the same country, depending
on ethnicity and velocity impact too.
17
The most
common clinical findings in this study were
subconjunctival acchymosis, followed by tenderness of
the zygomaticomaxillary buttresses, flattening of the
cheek, infra-orbital rim deformity, and paresthesia,
which is consistent with the study done by
Kambalimath et al.
15
and Patil et al.
16
In most of the
cases isolated ZMC fracture (47.7%) was seen in our
study which is in accordance with study by Zingg et
al.
13
(57%) and study by Ashwin et al
18
(54.35%). Lee
The Retrospective Comparison of Closed and Open Reduction
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J Gandhara Med Dent Sci
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et al.
19
in their study results demonstrated that fractures
with minimal or no displacement should be treated
conservatively or with closed reduction. Our study
revealed that 20 cases were treated by closed reduction,
which is consistent with the study by Kambalimath et
al.
15
In a similar study, Bradley et al.
20
treated 26
isolated ZMC fractures by closed reduction. This study
is also in accordance with our study. The most common
side involved in this study was the right side of the
cheek, which is similar to the results of the study done
by Menon et al.
14
Gomes et al.
21
showed that left side of
the face was most frequently involved in their study and
the reason that he concluded that most of the people are
right handed and mostly in danger side is left side of the
cheek thus, involving left side of ZMC. This study
contrasts with our study. In this study, the most
common site for one-plate fixation was the zygomatico-
maxillary buttress, which is consistent with a study by
Kim et al.
10
Kim found sufficient stability of the ZMC
fracture when one plate was used at the zygomatic
buttress area and verified this by a postoperative 3D CT
scan.
10
The overall complication rate was 20% with the
most common being infraorbital nerve paresthesia
(8.9%), followed by wound infection and mild diplopia.
These complications were transient and managed
conservatively. Dhabaria et al.
22
also revealed that
nerve paresthesia occurred in 10-20% of cases,
depending on the extent of injury and surgical
exposure. Our analysis also demonstrated a significant
dissatisfaction with closed reduction in managing ZMC
fractures. The findings of this study suggest several
important clinical implications. ORIF with multi-point
fixation should be the standard care for displaced and
comminuted ZMC fractures. Closed reduction should
be considered in minimally displaced fractures,
particularly in resource-limited settings, but with
caution due to the high risk of residual deformity.
Follow-up with clinical and radiographic evaluation is
essential for the timely detection of suboptimal healing
and esthetic compromise.
LIMITATIONS
This study is a retrospective, single-center study with a
lack of standardized outcome tools (patient-reported
esthetic and functional outcomes), limited follow-up
duration, and uncontrolled confounding variables.
Future studies may include prospective multicenter
trials, standardized outcome measurement tools,
extended long-term follow-up, 3D imaging, and
surgical navigation (3D virtual surgical planning,
intraoperative navigation), as well as patient-specific
implants in complex and comminuted ZMC fractures.
CONCLUSIONS
This study concluded that open reduction demonstrates
superior results in terms of healing, aesthetic
restoration, and complication rates compared to closed
reduction, particularly in displaced or comminuted
fractures. Closed reduction should be applied
judiciously in selective cases.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
REFERENCES
1. Brown Z, Perez D, Ellis E 3rd. Sequencing in orthognathic
surgery. In: Miloro M, Ghali GE, Larsen PE, Waite PD, editors.
Peterson’s Principles of Oral and Maxillofacial Surgery. Cham:
Springer International Publishing; 2022. p. 1945-67.
2. Ghasemi T, Khazaei AH, Teymoorpoor F, Haradasht SA.
Epidemiology of zygomaticomaxillary complex fracture in oral
and maxillofacial trauma patients. J Craniomaxillofac Res. 2023
Nov 12.
3. Panneerselvam E, Ravi P, Sasikala B. Fractures of the
zygomaticomaxillary complex. In: Balaji SM, editor. Oral and
Maxillofacial Surgery for the Clinician. Singapore: Springer
Nature Singapore; 2021. p. 1151-99.
4. Starch-Jensen T, Linnebjerg LB, Jensen JD. Treatment of
zygomatic complex fractures with surgical or nonsurgical
intervention: a retrospective study. Open Dent J. 2018;12:377-
87.https://doi.org/10.2174/1874210601812010377. PMID:
30197662.
5. Wang HD, Dillon J. Contemporary management of
zygomaticomaxillary complex fractures. Semin Plast Surg.
2021;35(4):256-62. doi: https://doi.org/10.1055/s-0041-
1739454. PMID: 34880863.
6. Birgfeld CB, Mundinger GS, Gruss JS. Evidence-based
medicine: evaluation and treatment of zygoma fractures. Plast
Reconstr Surg. 2017;139(1):168e-80e.
https://doi.org/10.1097/PRS.0000000000002875. PMID:
28027228.
7. Kambalimath DH, Kambalimath HV, Satyanarayan MVV,
Kumar VA, Ravikumar TG, Deepak RM. Retrospective analysis
of management of zygomatic complex fractures. Traumaxilla.
2023;5(1-3):20-6.
8. Garden OJ, Parks RW, Wigmore SJ, editors. Principles and
Practice of Surgery. 8th ed. Elsevier Health Sciences; 2022.
9. Singh V, Chhikara N, Jajodia N. Zygomaticomaxillary complex
fractures. In: Balaji SM, editor. Maxillofacial Trauma: A
Clinical Guide. Singapore: Springer Nature Singapore; 2021. p.
293-310.
10. Kim JH, Lee JH, Hong SM, Park CH. The effectiveness of 1-
point fixation for zygomaticomaxillary complex fractures. Arch
Otolaryngol Head Neck Surg. 2012;138(9):828-32.
https://doi.org/10.1001/archoto.2012.1713. PMID: 22986736.
11. Alshalah ME, Enezei HH, Aldaghir OM, Khalil AA, Aldelaimi
TN, Al-Ani RM. Direct or indirect surgical approach of
zygomatic complex fracture: a comparative study. J Craniofac
Surg. 2023;34(8):2433-6.
https://doi.org/10.1097/SCS.0000000000009924. PMID:
37601957.
12. Dakir A, Muthumani T, Prabu NP, Mohan R, Maity A. One
point fixation of zygomatic tripod fractures in the zygomatic
buttress through Keen's intraoral approach: a review of 30 cases.
J Pharm Bioallied Sci. 2015;7(Suppl 1):S238-41.
https://doi.org/10.4103/0975-7406.155965. PMID: 26015721.
The Retrospective Comparison of Closed and Open Reduction
17
J Gandhara Med Dent Sci
October - December 2025
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13. Zingg M, Laedrach K, Chen J, Chowdhury K, Vuillemin T,
Sutter F, et al. Classification and treatment of zygomatic
fractures: a review of 1,025 cases. J Oral Maxillofac Surg.
1992;50(8):778-90. https://doi.org/10.1016/0278-
2391(92)90241-7. PMID: 1634966.
14. Menon S, Sinha R, Thapliyal G, Bandyopadhyay T.
Management of zygomatic complex fractures in a tertiary
hospital: a retrospective study. J Maxillofac Oral Surg.
2011;10(2):138-41. https://doi.org/10.1007/s12663-011-0209-x.
PMID: 22754876.
15. Kambalimath DH, Kambalimath HV, Satyanarayan MVV,
Kumar VA, Ravikumar TG, Deepak RM. Retrospective analysis
of management of zygomatic complex fractures. Traumaxilla.
2023;5(1-3):20-6.
16. Patil AJ, Tolat T, Yelikar A, Kulkarni J. Incidence and
management of zygomaticomaxillary complex fractures treated
at Mahatma Gandhi Mission Hospital, Aurangabad,
Maharashtra. Int J Curr Med App Sci. 2019;22(2):11-5.
17. Forouzanfar T, Salentijn E, Peng G, van den Bergh B. A 10-
year analysis of the "Amsterdam" protocol in the treatment of
zygomatic complex fractures. J Craniomaxillofac Surg.
2013;41(7):616-22. https://doi.org/10.1016/j.jcms.2012.11.006.
PMID: 23219290.
18. Ashwin DP, Rohit Rajkumar GC. A study on assessing the
aetiology and different treatment modalities of
zygomaticomaxillary complex fracture. Int J Contemp Med Res.
2017;4(6):1423-30.
19. Lee EI, Mohan K, Koshy JC. Optimizing the surgical
management of zygomaticomaxillary complex fractures. Semin
Plast Surg. 2010;24(4):389-97. https://doi.org/10.1055/s-0030-
1269762. PMID: 22550464.
20. Bradley D, Leung B, Saxena S, Dungarwalla M, Chapireau D,
Fan K. Surgical management of zygomatic complex fractures in
a major trauma centre. Plast Aesthet Res. 2019;6:11.
https://doi.org/10.20517/2347-9264.2019.21.
21. Gomes PP, Passeri LA, Albergaria Barbosa JR. A 5-year
retrospective study of zygomatico-orbital complex and
zygomatic arch fractures in São Paulo State, Brazil. J Oral
Maxillofac Surg. 2006;64(1):63-7.
https://doi.org/10.1016/j.joms.2005.09.027. PMID: 16360586.
22. Dhabaria H, Kolari V, Sequeira J, Shah A. Evaluation of
infraorbital nerve recovery and its effect on quality of life
following open reduction and internal fixation of
zygomaticomaxillary complex fractures: an evaluative study.
Ann Maxillofac Surg. 2022;12(2):128-32.
https://doi.org/10.4103/ams.ams_372_21. PMID: 36643691.
AUTHORS CONTRIBUTION
The authors accept responsibility for all aspects of the work
and will ensure that any concerns regarding the accuracy or
integrity of any part are properly investigated and resolved.
Sehrish Liaqat - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical
Revision; Supervision; Final Approval
Anoosh Alishba - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Final Approval
Tehreem Malik - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Final Approval
Omaima Naeem - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Final Approval
Fazal Amin - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Final Approval
Abid Hussain Kanju - Concept & Design; Data Acquisition;
Data Analysis/Interpretation; Drafting Manuscript; Critical
Revision; Final Approval
The Retrospective Comparison of Closed and Open Reduction
