Poswillo Hook

This hook was designed by David Poswillo to reduce fractures involving Malar bones. Malar bone is accessed via an incision made in the cheek parallel to lower eyelids as shown in the figure below.






Stab incision is made at the junction of a vertical line dropped from the outer canthus of the eye and a Horizontal line drawn

along the upper lip.

The exact location of the stab wound is at the intersection of a perpendicular dropped from the outer canthus of the eye and a horizontal extended from the alar margin of the nostril. The depth of the incision is about 3 mm. Through this incision the blunt point of the malar hook is introduced until it is rotated to engage the deep aspect of the displaced malar bone.

While the free hand paplates the infraorbital margin the hook is frimly pulled upward and outward until the fracture is disimpacted. The bone easily returns to its original position easily with an audible click.

The advantages of the technique include the speed and effectiveness of reduction

of the fracture following a line of withdrawal almost identical to that occurring during inward impaction. The direct appliction of a withdrawal force is beleived to preserve may of the fragile bone spicules on the margins. These spicules are known to contribute to post reduction stability of the bone.


Direct application of traction force will succeed even if the impaction is severe and the treatment has been delayed for weeks.


The operating time is short (less than 5-10 mins) reducing the risks of anesthesia.


This method is unsuited for redcution of comminuted fractures.