Retrospective study about the postoperative stability of zygomaticomaxillary complex fracture

Seoghwan Yang,Jin-Yong Cho,Sungbeom Kim,Woo-Chul Shim

doi:10.1186/s40902-021-00311-9

Abstract

BackgroundThe aim of this study is to evaluate the postoperative stability of zygomaticomaxillary complex (ZMC) fractures according to the number of fixation sites and to investigate the direction of postoperative displacement of the unfixed part of the fractured segment.MethodsThis study was retrospectively performed on 38 patients who were treated by open reduction and internal fixation of ZMC fractures and were taken postoperative computed tomography (CT) between February 2012 and July 2019. The patients were classified into 3 groups: 1-point fixation, 2-point fixation, 3-point fixation according to the number of fixations. The postoperative displacement of the fractured segment was evaluated by the superimposition between postoperative CT and follow-up CT, and the postoperative stability according to the fixation sites was investigated through the amount of postoperative displacement. In addition, it was investigated in which direction the location of the fractured segment was changed in the unfixed fractured segment according to the fixation sites.ResultsThe amount of postoperative displacement of the fractured segment was 0.75 ± 1.18 mm on average.In the postoperative displacement of the distal area according to the number of fixation of the fracture, there was no statistically significant difference in the amount of displacement of the fracture (p = 0.574).As for the direction of the change in the location of the fractured segment, 12 patients among 38 patients with the change in the location of the fractured segment were investigated, and the displacement in the medial direction (n = 11, 91.67%) was the most common in all three fixation methods.ConclusionIn patients with a ZMC fracture who were treated by open reduction and internal fixation, the number of fixations did not make the difference in the postoperative displacement of the fracture. In addition, the fractured segment mainly changes in the medial direction after surgery, and this fact can be used as a reference for the reduction direction during surgery for the stable prognosis.

Highlights

The aim of this study is to evaluate the postoperative stability of zygomaticomaxillary complex (ZMC) fractures according to the number of fixation sites and to investigate the direction of postoperative displacement of the unfixed part of the fractured segment
Davidson et al ZMC fractures were fixed in various ways using mini-plates, and the maximum stability against physiological loads was achieved when all three points were fixed: frontozygomatic suture, inferior orbital rim, and zygomaticomaxillary buttress [3]
The direction and the amount of movement of the fixed sites were compared in 38 patients (12 patients with 1point fixation on ZM or FZ, 20 patients with 2-point fixation on ZM and infraorbital rim (IOR) or ZM and FZ, and 6 patients with 3-point fixation on ZM, IOF, and FZ sites)

Summary

Introduction

The aim of this study is to evaluate the postoperative stability of zygomaticomaxillary complex (ZMC) fractures according to the number of fixation sites and to investigate the direction of postoperative displacement of the unfixed part of the fractured segment. The zygomatic bone has a pyramidal structure and can be fixed at 4 locations (ZMB, zygomaticomaxillary buttress; FZ, frontozygomatic suture; IOR, infraorbital rim; ZA, zygomatic arch) when fracture occurred. A number of biophysical studies have been performed to determine the stability of ZMC fractures after open reduction surgery. Davidson et al ZMC fractures were fixed in various ways using mini-plates, and the maximum stability against physiological loads was achieved when all three points were fixed: frontozygomatic suture, inferior orbital rim, and zygomaticomaxillary buttress [3]. As the number of fixations increases and the procedure becomes more complex, there are disadvantages such as the formation of larger wounds, increasing the risk of wound swelling, infection, and scarring [3]

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