Abstract
PURPOSE: The increasing interest in minimally invasive procedures, which carries minimal risk for wound complications and scarring while also providing predictable outcomes, has brought attention to the concept of 1-point fixation in treating zygomaticomaxillary (ZMC) fractures. The primary aim of this study was to compare the intraoperative accuracy of repositioning following osteosynthesis with 1-point fixation versus multiple-point fixation in unilateral fractures of the ZMC complex. The secondary aim was to evaluate associations between trauma- and procedure-specific factors and the surgical outcomes of both fixation methods. METHODS: In this retrospective cohort single-centre study, patients who underwent surgical treatment for unilateral ZMC fractures using either 1-point or multiple-point fixation over a 7-year period were included. Forty-two patients were treated with 1-point fixation through an intraoral Keen's approach (group 1), while 20 patients were treated with multiple-point fixation through intraoral and extraoral approach (group 2). Demographic, clinical, radiological, and treatment data were analyzed. The degree of repositioning including protrusion difference of the zygoma (height, width, diagonal), malar difference using an asymmetry index, and difference in the intraorbital volume were measured comparing preoperative and intraoperative CT imaging. Multivariable analyses were conducted to compare the surgical outcomes in both groups and identify associations between the trauma- and procedure-specific variables and the intraoperative accuracy of fracture repositioning. RESULTS: A total of 62 patients with 62 unilateral ZMC fractures were included in the analysis. Violence was the most common mechanism of injury (n = 16; 25.8%). Forty-two patients underwent treatment with 1-point fixation, while 20 patients received multiple-point fixation. The intraoperative malar width difference and malar diagonal difference were significantly higher in group 1 (p = 0.003 / p = 0.036). No difference was detected in the intraorbital volume between the two fixation groups intraoperatively. Univariate analysis revealed that an interval between trauma-surgery of 3-7 days was significantly associated a better repositioning result in terms of intraorbital volume difference after multiple-point fixation (p = 0.03). CONCLUSIONS: This study shows that multiple-point fixation achieves superior accuracy in restoring zygomatic geometry, especially malar projection and transverse symmetry, while both techniques adequately restore intraorbital volume. Single-point fixation remains a viable, less invasive option for non-comminuted ZMC fractures when guided by intraoperative 3D imaging. The lack of revision surgeries in either group supports a tailored, fracture-specific strategy that balances precision with minimal invasiveness, consistent with trends toward individualized, resource-efficient trauma care.