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

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 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 I (heterogeneity) value of 89% and 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.