Meta-analysis of the Major Clinical Results of the Treatment with 1-Point Fixation in Fractures in the Zygomatic-Maxillary Complex: Success Rate and Complications

Introduction

Fractures of the zygomatic-maxillary complex (ZMC) are common facial fractures. After adequate fracture reduction, it is important to maintain stability and rigid fixation to avoid functional impairment and aesthetic sequelae. In this sense, the fixation of just one point can provide sufficient stability of the ZMC fracture when the ZMC fracture is not crushed.

Objective

To analyze the success rates of fracture stability of the ZMC, incidences of complications, and aesthetic satisfaction after 1-point fixation.

Methods

This study followed the rules of PRISMA, with publications from 2010 to 2020. The chi-square test and the Poisson probability test were performed to the occurrence of complications Low = 1, Moderate = 2, and NO = 0, adopting the α-level less than 0.05 with a statistical difference for 95% CI. The R-sq (R 2) value was also analyzed among the complications variables.

Results

The results of these studies showed in a general way that the use of 1-point fixation with open reduction presented good results in the short, medium, and long term, showing fracture stability. Complication rates were low and patients' satisfaction with aesthetics was considerable.

Conclusion

The success rate of the 1-point fixation procedure for the zygomatic-maxillary complex is high, with minimal complications.

Success of day-case treatment of zygomatic and orbital fractures

Traditionally, surgical management of zygomaticomaxillary complex (ZMC) and orbital fractures occurs within two to three weeks of the injury, followed by an overnight admission to allow for extended eye observations. This is due to the risk of postoperative retrobulbar haemorrhage (RBH) or orbital compartment syndrome (OCS), a rapidly progressive and sight threatening emergency that requires immediate intervention. In September 2016 the oral and maxillofacial surgery (OMFS) department at Leeds Teaching Hospitals redesigned their trauma service with a full-time trauma consultant, a dedicated clinic, and a weekly morning elective trauma theatre list. This allowed for standardisation of the management of patients with OMFS injuries. Furthermore, a formal day-case ZMC and orbital fracture pathway was developed to allow patients to undergo surgical management of such fractures with a same-day discharge. This has since been identified as an area of excellence by the Getting It Right First Time (GIRFT) programme, and is in line with the addition of ZMC and orbital fractures to the procedural list written by the British Association of Day Case Surgery (BADS). Unbeknown to the unit, the volume of day-case procedures was the highest within the UK, demonstrating the importance of GIRFT in highlighting areas of good or unique practice. The aim of this study was to determine the impact of our day-case pathway and designated OMFS trauma service on compliance with recent recommendations by GIRFT and BADS. Secondly, it was to determine the safety of same-day discharge with regards to postoperative complications.