Three-Dimensional Computed Tomography Analysis of Stability Following Two- and Three-Point Fixation With Biodegradable Plates Among Patients With Zygomatic Fracture

Abstract

Background: Open reduction followed by internal fixation has been regarded as the most effective technique for the surgical repair of zygomatic fractures. However, the ideal number and locations of internal fixation points to maintain stable reduction remain controversial. Using 3-dimensional computed tomography, we aimed to compare the stability of 2-point and 3-point fixation among patients who had undergone surgical repair of zygomatic bone fractures. Methods: The study included 22 patients (17 men, 5 women) with unilateral zygomatic bone fractures who had undergone open reduction with 2-point or three-point fixation using biodegradable materials (11 patients in each group). The authors measured the lateral projection and height of the zygoma at 2 landmark points (zygomaticofacial foramen and frontozygomatic suture). In each group, bony displacement was analyzed between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. Differences in stability between the 2 groups were analyzed by comparing values between the immediate postoperative and follow-up phases. Results: The 2-point group exhibited a lower rate of complex fractures at the frontozygomatic suture than the 3-point group (18.2%, 63.6%, respectively). In both groups, the authors observed significant differences in the lateral projection of the zygomaticofacial foramen between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. No significant differences in stability were observed between the groups. Conclusion: Our findings demonstrated that 2-point fixation of the zygoma with biodegradable materials is as stable as 3-point fixation. It could be initially considered when open reduction of frontozygomatic suture was not essential.

A tomada de decisão no uso de sistema de fixação absorvível em cirurgias bucomaxilofaciais: revisão sistemática

“…A estabilidade da fixação de pontos, sendo de 2 e 3 pontos utilizando somente materiais reabsorvíveis definiu que a fixação de 2 pontos do zigoma com materiais biodegradáveis é tão estável quanto a fixação de 3 pontos 22,24 , corroborando com os estudos de Ueki et al 25 , e Song et al 23 , onde revelaram que uma fixação híbrida de placas e parafusos absorvíveis pode ser útil e confiável em cirurgias ortognáticas e na diminuição de fraturas póscirúrgicas de corpo de mandíbula, respectivamente.…”

Management of Zygomatico maxillary complex fractures with two-point fixation-A retrospective study for 5 years

“…22 Na and Lim et al had found no difference in stability between two point and three point fixation however he found difference in the facial projection. 23 Wail et al compared two and three point fixation in two groups and evaluated surgical outcomes with CT scans. He found no significant difference in stability and concluded that two-point fixation is as good as three-point fixation with respect to stability of fractures.…”

Comparison of the Biomechanical Stiffness of Titanium and Sonic Weld RX Osteofixation Systems for Monoblock Zygomaticomaxillary Complex Fractures

“…In the 2-point fixation model, FZ fixation is indispensable based on a report pointing out that this site is the most critical region for fixation of ZMC fracture. 3,25 In a mechanical test, strength usually indicates a load value, which, when applied, causes the specimen to reach the fracture or yield point. On the other hand, stiffness is a property that resists deformation when an external force is applied to the specimen.…”

“…Our ZMC fractured model was fixed using 2- and 3-points. In the 2-point fixation model, FZ fixation is indispensable based on a report pointing out that this site is the most critical region for fixation of ZMC fracture 3,25 …”