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

C. Sai Kumar; Khundongbam Palin Singh; Tamphaleima Sorokhaibam; Karthika Sobha Pillai; Varun Lokesh

doi:10.18203/2349-2902.isj20252276

Authors

C. Sai Kumar Department of Plastic and Reconstructive Surgery, Shija Hospitals and Research Institute, Imphal West, Manipur, India
Khundongbam Palin Singh Department of Plastic and Reconstructive Surgery, Shija Hospitals and Research Institute, Imphal West, Manipur, India
Tamphaleima Sorokhaibam Department of Plastic and Reconstructive Surgery, Shija Hospitals and Research Institute, Imphal West, Manipur, India
Karthika Sobha Pillai Department of Plastic and Reconstructive Surgery, Shija Hospitals and Research Institute, Imphal West, Manipur, India
Varun Lokesh Department of Plastic and Reconstructive Surgery, Shija Hospitals and Research Institute, Imphal West, Manipur, India

DOI:

https://doi.org/10.18203/2349-2902.isj20252276

Keywords:

Open reduction internal fixation, Tripod fracture, Two-point fixation, Three-point fixation, Zygomaticomaxillary complex

Abstract

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.

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