An Optimal Postoperative Symmetry After Two-Point Fixation with Open Reduction in Internal Fixation of Complex Zygomaticomaxillary Fractures: A Radiographic Analysis

Abstract Background Zygomatico-Maxillaris Complex (ZMC) fractures are the second most common fractures after nasal fractures. Open Reduction Internal Fixation (ORIF) is the most preferable treatment option in the management of ZMC fractures, mainly aiming at achieving maximum reduction and stability to prevent from micromovement. There is no consistency in the number of fixation points required to achieve stability. The study was aimed at evaluating the difference in the number of fixation points on radiographic symmetry after ORIF. Methods This retrospective study used Water's radiographic data from patients who had undergone ORIF, with predetermined patient inclusion criteria. The data were grouped into group A (1-point fixation), group B (2-point fixation), and group C (3-point fixation), each of which comprised 20 samples, and observations were made on day 3 postoperatively. Symmetry was analyzed using the symmetry index and Bland Altman analysis by comparing the non-fracture side and the fracture side after ORIF in unilateral ZMC fractures. Results Post Hoc LSD statistical tests showed that the smallest symmetry index was found in group B (0.42 ± 0.16) compared to group C (0.45 ± 0.18) and group A (0.79 ± 0.22) with P value of 0.63 and 0.00, respectively. Bland-Altman analysis with a 95% limit of agreement showed the smallest limit also in group B, which means that group B had the best symmetry, followed by group C and group A, but overall all groups showed symmetry. Conclusion The number of fixation points affects the symmetry of the zygomatic bone in patients with unilateral ZMC fractures after ORIF. The use of 2 fixation points in ZMC fractures results in the best symmetry.