A Retrospective Comparative Study of Open Reduction and Internal Fixation (ORIF) versus Open Reduction in Zygomaticomaxillary Complex (ZMC) Fractures at Sakon Nakhon Hospital
Keywords:
ZMC fracture, Traditional three-point fixation, Malar height, Vertical dystopiaAbstract
This retrospective comparative study was conducted to evaluate clinical outcomes, postoperative complications, and cost-effectiveness of open reduction and internal fixation (ORIF) versus open reduction alone in the management of zygomaticomaxillary complex (ZMC) fractures. The comprehensive review of medical records and three-dimensional computed tomography imaging of 210 patients with unilateral ZMC fractures who underwent surgical treatment at Sakon Nakhon Hospital from June 2018 to June 2023 were performed. The patients were stratified into three distinct therapeutic groups: Group 1 underwent open reduction alone, Group 2 received open reduction with two-point ORIF, and Group 3 was treated with open reduction combined with three-point ORIF. Primary outcome measures included malar height restoration, vertical dystopia correction, osseous stability, and postoperative complications.
The results showed significantly superior malar height restoration in patients treated with two-point and three-point ORIF compared to those managed with open reduction alone at the 6-week follow-up assessment (p < 0.04). Vertical dystopia was significantly lower in both ORIF cohorts relative to the open reduction monotherapy group at the 6-week postoperative evaluation (p < 0.001). Osseous stability proportions were markedly higher in the two-point and three-point ORIF groups compared to the open reduction alone cohort. Operative duration was prolonged for the three-point ORIF technique. The three-point ORIF technique demonstrated superior therapeutic efficacy in achieving anatomical malar height restoration, minimizing vertical dystopia, and establishing robust osseous stability compared to open reduction monotherapy. However, the extended operative time associated with three-point ORIF warrants careful consideration in surgical planning and patient selection. These findings provide evidence-based guidance for clinicians in optimizing treatment algorithms for ZMC fractures, enabling individualized therapeutic decision-making based on fracture morphology, patient comorbidities, and functional requirements.
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