One-Point vs. Two-Point vs. Three-Point Fixation for Unstable Pediatric Zygomaticomaxillary Complex Fractures
JD Luck, Joseph Lopez, Muhammad Faateh, Alexander Macmillan, Robin Yang, Edward Davidson, Arthur Nam, Anthony P. Tufaro, Richard Redett, Paul Manson, Amir Dorafshar.
Johns Hopkins School of Medicine, Baltimore, MD, USA.
Currently, there is a paucity of data investigating the proper operative management of pediatric ZMC fractures. The purpose of this study was to assess ZMC fracture management and associated complications in the pediatric trauma population.
A retrospective cohort review was performed of all patients younger than 15 years of age presenting to the Johns Hopkins Hospital with ZMC fractures from 1990-2010. Patient demographics, concomitant injuries, management details, and complications were recorded. Complications were compared among patients by dentition stage, number of fixation points, and identity of fixation sites.
A total of 36 patients with 44 unique ZMC fractures met our inclusion criteria. Twelve ZMC fractures were labeled as Type-I (27.3%) while 32 ZMC fractures were categorized as Type-II (72.7%). Among operatively managed patients with deciduous dentition, two-point fixation was associated with a lower overall complication rate when compared to one- and three-point fixation (0% vs. 75% and 75%, p = 0.01). Furthermore, rigid plate and screw fixation at the zygomaticomaxillary buttress (ZMB) was not associated with an increased complication rate in operatively managed patients with deciduous dentition (40% vs. 50%, p = 0.76).
Our results suggest that two-point fixation (ZM and ZF) may be optimal in the deciduous dentition population. Our results also demonstrated no association between complication rate and rigid plate and screw fixation at the ZMB in children with deciduous dentition. Future multi-center, prospective trials will be necessary to fully corroborate our results and provide conclusive recommendations regarding these important clinical questions.
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