Internal fixation of mandibular angle fractures: a meta-analysis.
BACKGROUND
The degree of rigidity of internal fixation required for the treatment of mandibular angle fractures has long been at the center of debate in the literature. A statistical comparison between rigid fixation and monocortical fixation has been difficult because of multiple terms, definitions, and technical variations. The purpose of this study was to use the meta-analysis tool to combine information from multiple studies and to compare complication rates for different fixation methods.


METHODS
An English language literature search was conducted for articles on mandibular angle fractures. Information was collected on four variables of interest: compression/noncompression technique, monocortical/bicortical screws, number of plates, and location of plates. Five outcome rates were analyzed: infection, reoperation, hardware removal, malunion, and nonunion. Meta-analyses were run using Comprehensive Meta Analysis, version 2.2.03.


RESULTS
Twenty-four studies with relevant data on the variables and outcomes of interest met the inclusion criteria. Significantly higher rates of infection, reoperation, and hardware removal were found for compression compared with noncompression, two plates compared with one plate, and for plates located on both the inferior and superior borders as compared with superior or inferior only. There were also significantly higher infection rates for bicortical screws compared with monocortical screws and higher malunion rates for compression compared with noncompression plating techniques.


CONCLUSIONS
The results of this meta-analysis found lower complication rates with the use of noncompression, monocortical, and single-plate fixation, supporting the trend toward a single, superiorly placed, monocortical miniplate for fixation of mandibular angle fractures.
Toronto, 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.
Eran
E
Regev
Jacob S
JS
Shiff
Alex
A
Kiss
Jeffrey A
JA
Fialkov
D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D008337:Mandibular Fractures / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*