Three point fixation is superior to two point fixation technique for zygomatic complex fracture


  • Gul Zaman College of Dentistry, Multan Medical and Dental College, Multan, Pakistan
  • Muhammad Azeem Khan College of Dentistry, Multan Medical and Dental College, Multan, Pakistan
  • Muhammad Zeshan Hyder College of Dentistry, Multan Medical and Dental College, Multan, Pakistan
  • Taimur ul Hassan College of Dentistry, Bakhtawar Amin Medical and Dental College, Multan, Pakistan
  • Afifa Zafar College of Dentistry, Multan Medical and Dental College, Multan, Pakistan
  • Waleed Ashraf College of Dentistry, Multan Medical and Dental College, Multan, Pakistan
  • Muhammad Kashif College of Dentistry, Bakhtawar Amin Medical and Dental College, Multan, Pakistan



Malar height, Two point fixation, Three point fixation, Zygomatic complex fracture


Background: Isolated zygomatic or malar bone fractures are second most common fracture among facial skeletal injuries. It has been reported that three point fixation is appropriate for isolated zygomatic bone fracture. The objective of current study was to compare the mean difference in terms of malar height outcome by using different fixation techniques (two point and three point) in patients with zygomatic complex fracture.

Methods: This randomized controlled trial was conducted at Department of Oral and Maxillofacial Surgery, MMDC, Multan, during a period of six months from 1st June 2017 to 30th November 2017. A total 182 patients of both genders were included in this study. Two point fixation techniques were used in Group-A patients. While 3 point fixation was used in Group-B patients. After 6 weeks follow-up, patients were assessed for malar height. Outcome was measured by comparing the mean difference of pre and postoperative malar height of both techniques. Data were analyzed using computer program SPSS-21. P≤0.05 was taken as significant in all analysis.

Results: Among patients in two point fixation group, the mean malar height was 67.55±2.98 mm and in three point fixation group, means malar height was 71.55±2.36 mm. The difference of malar height among two treatments was highly significant with p<0.01.

Conclusions: Using three point fixation results better as compared to two point fixations in terms of malar height outcome.


Iqbal HA, Chaudhry S. Choice of operative method for management of isolated zygomatic bone fractures; evidence based study. J Pak Med Assoc. 2009;59(9):615-8.

Czerwinski M, Martin M, Lee C. Quantitative comparison of open reduction and internal fixation versus the Gillies method in the treatment of orbitozygomatic complex fractures. Plast Reconstr Surg. 2005;115:1848-54.

Gruss JS, Van Wyck L, Phillips JH. The importance of the zygomatic arch in complex midfacial fracture repair and correction of posttraumatic orbitozygomatic deformities. Plast Reconstr Surg. 1990;85:878.

Hussain S, Rizvi ZA. Optimization of management for zygomatic complex fractures: a study at tertiary care teaching hospital in Pakistan. J Pak Dent Assoc. 2010;19(3):164-8.

Motamedi MH. An assessment of maxillofacial fractures: a five-year study of 237 patients. J Oral Maxillofac Surg. 2003;61:61-4.

Stanley RB: The zygomatic arch as a guide to reconstruction of comminuted malar fractures. Arch Otolaryngol Head Neck Surg. 1989;115:1459.

Souyris K, Kersy F, Jammet P. Malar bone fractures and their sequelae. A statistical study of 1,393 cases covering a period of 20 years. J Craniomaxillofac Surg. 1989;17:64-8.

Loughlin M, Gilhooly M, Wood G. The management of zygomatic complex fractures-results of a survey. Br J Oral Maxillofac Surg. 1994;32:284-8.

Rana M, Warraich R, Tahir S, Iqbal A, von See C, Eckardt AM, et al. Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation-a randomised prospective clinical trial. Trials. 2012;13(1):36.

Lee PK, Lee JH, Choi YS. Single transconjunctival incision and two-pointfixation for the treatment of noncomminute dzygomatic complex fracture. J Korean Med Sci. 2006;21:1080-5.

Courtney DJ. Upper buccal sulcus approach to management of fractures of the zygomatic complex: a retrospective study of 59 cases. Br J Oral Maxillofac Surg. 1999;37:464-8.

Ellis E, Kittidumkerng W. Analysis of treatment for isolated zygomaticomaxillary complex fractures. J Oral Maxillofac Surg. 1996;54:386-400.

Davidson J, Nickerson D, Nickerson B. Zygomatic fractures: Comparison ofmethod of internal fixation. Plast Reconstr Surg. 1990;86:25-32.

David DJ. Facial fracture classification: current thoughts and applications. J Craniomaxillofac Trauma. 1999;5:31-6.

Chakranarayan A, Thapliyal GK, Sinha R, Suresh MP. Efficacy of two point rigid internal fixation in the management of zygomatic complex fracture. J Maxillofac Oral Surg. 2009;8(3):265-9.

Miloro M, Ghali GE, Larsen PE. Peterson’s principles of oral and maxillofacial surgery. Hamilton, Decker BC, editors. 2nd edition. 2004: 447–451.

Zachariades N, Mezitis M, Anagnostopoulos D. Changing trends in the treatment of zygomaticom axillary complex fractures: A 12 year evaluation of the methods used. J Oral Maxillofac Surg. 1998;56(10):1156–7.

Rudderman RH, Mullen RL. Biomechanics of facial skeleton. Clin Plast Surg. 1992;19:11-29.

Pearl RM. Treatment of enophthalmos. Clin Plast Surg. 1992;19:99-111.

Davidson J, Nickerson D, Nickerson B. Zygomatic fractures: comparison of methods of internal fixation. Plast Reconstr Surg. 1990,86:25-32.

O’Hara DE, Delvecchio DA, Bartlett SP. The role of microfixation in malar fractures: a quantitative biophysical study. Plast Reconstr Surg. 1996;97:345-53.

Fujioka M, Yamanoto T, Miyazato O, Nishimura G. Stability of one-plate fixation for zygomatic bone fracture. Plast Reconstr Surg. 2002;109:817-8.

Jansma J, Bos RR, Vissink A. Zygomatic fractures. Ned Tigdschr Tandheekd. 1997;104:436-9.

Jackson IT, Somers PC, Kjar JG. The use of Champy miniplates for osteosynthesis in craniofacial deformities and trauma. Plast Reconstr Surg. 1986;77:729-36.

Ikemura K, Hidaka H, Etoh T, Kabata K. Osteosynthesis in facial bone fractures using miniplates: Clinical and experimental studies. J Oral Maxillofac Surg. 1988;46:10-4.

Keles B, Oztürk K, Arbað H, Han Ulkü C, Gezgin B. Treatment options and common problems in patients with maxillofacial trauma. Ulus Travma Acil Cerrahi Derg. 2006;12:218-22.

Dal Santo F, Ellis E, Throchmorton GS. The effects of zygomatic complex on massetric muscle force. J Oral Maxillofac Surg. 1992;50:791-9.

Hwang K. One-point fixation of tripod fractures of zygoma through a lateral brow incision. J Craniofac Surg. 2010;21:1042-4.

Kim ST, Go DH, Jung JH, Cha HE, Woo JH, Kang IG. Comparison of 1-point fixation with 2-point fixation in treating tripod fractures of the zygoma. J Oral Maxillofac Surg. 2011;69:2848-52.

Becelli R, Quarato D, Matarazzo G, Renzi G, Dominici C. Esthetic positioning of rigid internal fixation in tripod zygomatic fractures: An innovative surgical technique. J Craniofac Surg. 2009;20:724-5.

Oji C. Jaw fractures in Enugu, Nigeria. 1985-1995. Br J Oral Maxillofac Surg. 1999;37:106-9.






Original Research Articles