Publication:

Radiological assessment of two-point versus three-point fixation in unilateral zygomatic tripod fractures: a comparative study

Background Zygomaticomaxillary complex (ZMC) fractures, common in craniofacial trauma, require precise surgical management to restore function and aesthetics. This prospective randomized interventional study compared outcomes of two-point versus three-point fixation in 160 patients with unilateral ZMC tripod fractures at Shija Hospitals, Imphal, from December 2019 to December 2024.

Methods Patients aged 14–60 years presenting within 3 days of injury were randomized into two groups (n=80 each): Group A (two-point fixation at frontozygomatic and infraorbital rim) and Group B (three-point fixation, adding zygomaticomaxillary buttress). Radiological outcomes, including zygomatic projection, height and vertical dystopia, were assessed via CT scans at 6 weeks post-surgery using GE Healthcare’s Media Viewer

Results Three-point fixation demonstrated significantly better improvement in zygomatic projection (3.37±0.74 mm vs. 2.9±0.52 mm, p=0.002), height (2.81±0.42 mm vs. 2.57±0.46 mm, p=0.015) and vertical dystopia (2.43±0.56 mm vs. 2.12±0.53 mm, p=0.01) compared to two-point fixation. No postoperative complications (e.g., infection, plate exposure or enophthalmos) or loss to follow-up were reported. Males (76.25%) and the 20–35 age group were predominantly affected, with road traffic accidents as the leading cause.

Conclusions Despite advantages, three-point fixation involves longer operative time and higher costs. This study concludes that three-point fixation offers superior radiological outcomes for ZMC fracture reduction, supporting its use despite increased resource demands.