One-point versus two-point fixation of tripodal zygomatic fractures

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Abstract

Background
The zygomaticomaxillary complex (ZMC) fractures are highly frequent injuries. There is a variety of operative techniques for fixation of ZMC fractures, with no consensus about the best technique. We aim to compare one-point versus two-point fixation of tripodal zygomatic fractures.
Patients and Methods
This prospective randomized controlled clinical trial was carried out on 68 patients admitted to the trauma unit in Assiut university hospital, in the period from September 2019 to March 2021. Patients were divided into two groups (group 1; one-point fixation, and group 2; two- point fixation). The degree of success of reduction and fixation was evaluated by measuring the diastasis of ZMC fracture at the inferior orbital (IO) rim on postoperative CT scan; and by clinical evaluation of symmetry between zygomatic eminences.
Results
Post-operative diastasis between the fracture ends was 1.20 ± 0.80 mm in the one-point fixation group, and was 0.99 ± 0.64 mm in the two-point fixation group; (=0.40). Malar symmetry was detected in (94.1%) of patients in the one-point fixation group, and in (97%) of patients in the two- point fixation group; (=0.56). The unsightly scar was seen only in cases of two-point fixation group (41.2%), (< 0.001). The plate was palpable only in patients of the two-point fixation group (35.3%) at the frontozygomatic region, (<0.001). Patient’ satisfaction with surgical outcomes was significantly higher in the one-point fixation group (94.1%) vs. (58.8%) in the two-point fixation group, (<0.001).
Conclusion
The one-point fixation technique for tripodal ZMC fractures is considered effective as the two-point fixation technique; and it offers advantages of scarless operation, reduced operation time, fewer complications, and lower cost.

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