Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of Two-Point Versus Three-Point Fixation for Zygomaticomaxillary Fractures: A Systematic Review and Meta-analysis

  • REVIEW PAPER
  • Published:
Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Background

The zygomaticomaxillary complex (ZMC) functions as the main buttress for the lateral portion of the middle third of the facial skeleton and because of its prominent position & convex shape, it is frequently fractured, alone or along with other bones of the midface. The management of the ZMC fractures is debatable as the literature is saturated with various theories. A number of techniques, from closed reduction to open reduction and internal fixation can be effectively used to manage these fractures. Controversies lie right from the amount of fixation (mostly 2-, 3-point fixation) required to the ideal approach, and there is no conclusive view on its ideal line of management.

Aim

To systematically review the existing scientific literature to determine whether two-point or three-point fixation is a better treatment alternative for the patients with zygomaticomaxillary fractures through a meta-analysis.

Methods

Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, Google scholar and Ebsco Host were searched from January 2000 to November 2023 for studies reporting treatment of zygomaticomaxillary fractures through two-point and three-point fixation and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included was evaluated using Cochrane risk of bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value < 0.05 as statistically significant.

Results

Eleven studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only eight studies were suitable for meta-analysis. The pooled estimate through the standardized mean difference (SMD) of – 0.21 (– 0.83–0.41) favors two-point fixation employing random effect model with I2 (heterogeneity) value of 89% and p value 0.51. Publication bias through the funnel plot showed asymmetric distribution with systematic heterogeneity.

Conclusion

In our systematic review, we aimed to evaluate which method of fixation is more effective in the treatment of zygomaticomaxillary complex fractures. Our pooled estimate using quantitative synthesis indicates that both two- and three-point fixation procedures are equally effective in the treatment of zygomaticomaxillary fractures. As a result, two-point fixation is as efficient as three-point fixation in treating zygomaticomaxillary complex fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ellis E III, El-Attar A, Moos KF (1985) An analysis of 2,067 cases of zygomatico-orbital fracture. J Oral Maxillofac Surg 43(6):417–428

    Article  PubMed  Google Scholar 

  2. Strong EB, Gary C (2017) Management of zygomaticomaxillary complex fractures. Fac Plast Surg Clin 25(4):547–562

    Article  Google Scholar 

  3. Enislidis G, Pichorner S, Kainberger F, Ewers R (1997) Lactosorb panel and screws for repair of large orbital floor defects. J Cranio-Maxillofac Surg 25(6):316–321

    Article  CAS  Google Scholar 

  4. Ellstrom CL, Evans GR (2013) Evidence-based medicine: zygoma fractures. Plast Reconstr Surg 132(6):1649–1657

    Article  CAS  PubMed  Google Scholar 

  5. Kelley P, Hopper R, Gruss J (2007) Evaluation and treatment of zygomatic fractures. Plast Reconstr Surg 120(7):5S-15S

    Article  CAS  PubMed  Google Scholar 

  6. Rudderman RH, Mullen RL (1992) Biomechanics of the facial skeleton. Clin Plast Surg 19(1):11–29

    Article  CAS  PubMed  Google Scholar 

  7. Vriens JP, van der Glas HW, Moos KF, Koole R (1998) Infraorbital nerve function following treatment of orbitozygomatic complex fractures: a multitest approach. Int J Oral Maxillofac Surg 27(1):27–32

    Article  CAS  PubMed  Google Scholar 

  8. Ellis E, Kittidumkerng W (1996) Analysis of treatment for isolated zygomaticomaxillary complex fractures. J Oral Maxillofac Surg 54(4):386–400

    Article  PubMed  Google Scholar 

  9. Olate S, Lima SM Jr, Sawazaki R, Moreira RW, de Moraes M (2010) Surgical approaches and fixation patterns in zygomatic complex fractures. J Craniofac Surg 21(4):1213–1217

    Article  PubMed  Google Scholar 

  10. Zingg M, Laedrach K, Chen J, Chowdhury K, Vuillemin T, Sutter F, Raveh J (1992) Classification and treatment of zygomatic fractures: a review of 1,025 cases. J Oral Maxillofac Surg 50(8):778–790

    Article  CAS  PubMed  Google Scholar 

  11. Bao T, Yu D, Luo Q, Wang H, Liu J, Zhu H (2019) Quantitative assessment of symmetry recovery in navigation-assisted surgical reduction of zygomaticomaxillary complex fractures. J Cranio-Maxillofac Surg 47(2):311–319

    Article  Google Scholar 

  12. Meslemani D, Kellman RM (2012) Zygomaticomaxillary complex fractures. Arch Facial Plast Surg 14(1):62–66

    Article  PubMed  Google Scholar 

  13. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group* (2009) Preferred reporting items for systematic reviews and meta-analyzes: the PRISMA statement. Ann Intern Med 151(4):264–269

    Article  PubMed  Google Scholar 

  14. Corbett MS, Higgins JP, Woolacott NF (2014) Assessing baseline imbalance in randomized trials: implications for the Cochrane risk of bias tool. Res Synth Method 5(1):79–85

    Article  Google Scholar 

  15. DerSimonian R, Laird N (2015) Meta-analysis in clinical trials revisited. Contemp Clin Trials 1(45):139–145

    Article  Google Scholar 

  16. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558

    Article  PubMed  Google Scholar 

  17. Sterne JA, Becker BJ, Egger M. The funnel plot. Publication bias in meta-analysis: prevention, assessment and adjustments. 2005:75–98

  18. Candamourty R, Narayanan V, Baig MF, Muthusekar MR, Jain MK, Babu RM (2013) Treatment modalities in zygomatic complex fractures: a prospective short clinical study. Dent Med Res 1(1):13

    Article  Google Scholar 

  19. Dutt M (2018) Comparison of 2 point and 3 point fixation of zygomatic bone fractures-a clinical study. Ind Dent Assoc Ludhiana 2:41–44

    Google Scholar 

  20. Gawande MJ, Lambade PN, Bande C, Gupta MK, Mahajan M, Dehankar T (2021) Two-point versus three-point fixation in the management of zygomaticomaxillary complex fractures: a comparative study. Ann Maxillofac Surg 11(2):229

    Article  PubMed  PubMed Central  Google Scholar 

  21. Atul P, Ramesh KS, Surinder M (2007) Rigid internal fixation of zygoma fractures: a comparison of two-point and three-point fixation. Indian J Plast Surg 40(01):18–24

    Google Scholar 

  22. Kim HJ, Bang KH, Park EJ, Cho YC, Sung IY, Son JH (2018) Evaluation of postoperative stability after open reduction and internal fixation of zygomaticomaxillary complex fractures using cone beam computed tomography analysis. J Craniofac Surg 29(4):980–984

    Article  PubMed  Google Scholar 

  23. Ji SY, Kim SS, Kim MH, Yang WS (2016) Surgical methods of zygomaticomaxillary complex fracture. Arch Craniofac Surg 17(4):206

    Article  PubMed  PubMed Central  Google Scholar 

  24. Zaman G, Khan MA, Hyder MZ, Hassan TU, Zafar A, Ashraf W (2019) Three-point fixation is superior to two-point fixation technique for zygomatic complex fracture. Int J Clin Trials 6(4):61

    Article  Google Scholar 

  25. Hasse PN, Gealh WC, Pereira CC, Coradazzi LF, Magro Filho O, Junior IR (2011) Clinical and radiographic evaluation of surgical treatment of zygomatic fractures using 1.5 mm miniplates system. Open J Stomatol 1(04):172

    Article  Google Scholar 

  26. Latif K, Alanazi YM, Alrwuili MR, Alfergani SM, Alenzi NA, Alqarni AS (2017) Post operative outcomes in open reduction and internal fixation of zygomatic bone fractures. Pak Oral Dent J 37(4):523–530

    Google Scholar 

  27. Nasr WF, ElSheikh E, El-Anwar MW, Sweed AH, Bessar A, Ezzeldin N (2018) Two-versus three-point internal fixation of displaced zygomaticomaxillary complex fractures. Craniomaxillofac Trauma Reconstr 11(4):256–264

    Article  PubMed  Google Scholar 

  28. Rana M, Warraich R, Tahir S, Iqbal A, Von See C, Eckardt AM, Gellrich NC (2012) Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation-a randomized prospective clinical trial. Trials 13(1):1

    Article  Google Scholar 

  29. Raghoebar II, Rozema FR, de Lange J, Dubois L (2022) Surgical treatment of fractures of the zygomaticomaxillary complex: effect of fixation on repositioning and stability. A systematic review. Br J Oral Maxillofac Surg 60(4):397–411

    Article  PubMed  Google Scholar 

Download references

Funding

Nil.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Dayananda Sagar College of Dental Sciences, Bangalore, India

    Neha Nainoor, E. S. Shobha, N. T. Prashanth, Vinod Rangan, Rayan Malick & Shavari Shetty

Authors
  1. Neha Nainoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. S. Shobha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. T. Prashanth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vinod Rangan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rayan Malick
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shavari Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neha Nainoor.

Ethics declarations

Conflict of interest

Nil.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nainoor, N., Shobha, E.S., Prashanth, N.T. et al. Efficacy of Two-Point Versus Three-Point Fixation for Zygomaticomaxillary Fractures: A Systematic Review and Meta-analysis. J. Maxillofac. Oral Surg. (2024). https://doi.org/10.1007/s12663-024-02139-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12663-024-02139-y

Keywords

Search

Navigation