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Internal fixation of mandibular angle fractures: a meta-analysis
Eran Regev1, Jacob S Shiff, Alex Kiss
1Toronto, Ontario, Canada; and Jerusalem, Israel From the Department of Research Design and Biostatistics and the Division of Plastic Surgery, Sunnybrook Health Sciences Centre, and the Department of Oral and Maxillofacial Surgery, Hadassah-Hebrew University Medical Centre.
Noncompression, monocortical, and single-plate fixation methods are associated with lower complication rates for mandibular angle fractures. This meta-analysis supports using a single, superiorly placed, monocortical miniplate for optimal treatment outcomes.
Area of Science:
- Oral and Maxillofacial Surgery
- Biomaterials Science
- Surgical Outcomes Research
Background:
- The optimal internal fixation rigidity for mandibular angle fractures remains debated.
- Previous comparisons of rigid vs. monocortical fixation are hindered by varied terminology and techniques.
- A meta-analysis is needed to consolidate evidence and compare complication rates.
Purpose of the Study:
- To compare complication rates for different fixation methods in mandibular angle fractures using meta-analysis.
- To identify fixation variables associated with specific adverse outcomes.
Main Methods:
- A systematic literature search identified 24 studies on mandibular angle fractures.
- Data were collected on compression technique, screw type (monocortical/bicortical), plate number, and plate location.
- Five outcome rates (infection, reoperation, hardware removal, malunion, nonunion) were analyzed via meta-analysis.
Main Results:
- Compression fixation, two plates, and dual-border plate placement showed significantly higher infection, reoperation, and hardware removal rates.
- Bicortical screws correlated with higher infection rates, while compression plating increased malunion rates.
- Noncompression, monocortical, and single-plate fixation demonstrated lower complication rates.
Conclusions:
- Noncompression, monocortical, and single-plate fixation strategies are associated with reduced complications in mandibular angle fracture treatment.
- Evidence supports the use of a single, superiorly placed, monocortical miniplate for mandibular angle fracture fixation.
