Does additional intraoperative imaging improves outcomes in isolated zygomatic arch fractures: Systematic review

Abstract

PurposeTo review the state-of-art and advances in the use of intraoperative imaging and its benefits on overall adequacy of reduction of depressed zygomatic arch fractures compared to the conventional blind reduction technique. Materials and methodsPubMed, Embase, Cochrane Central Register of Controlled Trials, Clinical Trials Registry, and a manual search of selected journals and the reference list of included articles was performed up until June 2020. Two randomized controlled trials and three retrospective cohort studies fulfilled the inclusion criteria. Qualitative synthesis of all the outcomes and studies was done. Metanalysis was performed for the completely reported outcomes. ResultsThere was a statistically significant difference in the overall adequacy of reduction based on clinical and radiographic assessments, Z = 2.30 (P = .02) in favour of imaging guided reduction. There was less residual cortical step and dislocation angle in the imaging group, Z = 2.62 (P = .009). There was no reoperation in imaging guided group compared to two cases of reoperations in the blind group. The mean time required for imaging guided reduction was more compared to the blind reduction. ConclusionsImaging guided reduction of zygomatic arch results in lesser number of reoperations and better overall reduction. There is a relative reduction in risk of postoperative complications, and the evidence is moderately certain. Conclusions drawn from the results of this systematic review are promising, and it can be used to form the basis of randomized clinical trials to evaluate intraoperative imaging modalities in reduction of isolated zygomatic arch fractures.