F: Zygomaticomaxillary Complex Fracture Repositioning Using Plates & Screws (Standard Techniques and Modifications) with Consideration of Effectiveness Costs

Abstract

Background: Zygomaticomaxillary complex (ZMC) fractures are common midfacial injuries that affect facial aesthetics and function. Although multipoint fixation is traditionally recommended, minimal fixation may offer comparable outcomes with greater efficiency. Objective: This review evaluated clinical outcomes and cost-effectiveness of one-, two-, and three-point fixation in ZMC fracture management. Methods: A PRISMA 2020–guided literature review was conducted using PubMed, ScienceDirect, Google Scholar, and ResearchGate. Eighteen eligible studies assessing plate-and-screw fixation techniques were qualitatively analyzed. Results: One- and two-point fixation achieved postoperative stability, facial symmetry, and orbital function comparable to three-point fixation when adequate reduction was obtained. Complication rates were low and showed no significant differences among techniques, while minimal fixation reduced operative time, implant use, and costs. Outcomes were more dependent on reduction quality and fixation site selection than fixation number. Conclusion: One- or two-point fixation is a safe and effective alternative to multipoint fixation in selected ZMC fractures, offering optimal outcomes with improved surgical efficiency and cost-effectiveness.

Keywords: zygomaticomaxillary complex fracture; internal fixation; one-point fixation; two-point fixation; cost-effectiveness