Three-Dimensional Strut Plate for the Treatment of Mandibular Fractures: A Systematic Review and Meta-Analysis

ABSTRACT Background: Mandibular fractures represent one of the most common facial skeletal injuries worldwide, accounting for 36–59% of all maxillofacial fractures. The introduction of three-dimensional (3D) strut plates, conceptualized by Farmand in 1995, sought to combine the biomechanical advantages of two parallel bars positioned along the lines of osteosynthesis described by Champy with the additional resistance to torsional forces afforded by vertical interconnecting bars. Whether this geometric configuration translates into superior clinical outcomes compared with conventional miniplates remains debated. Objectives: To systematically review and quantitatively synthesize the current evidence comparing 3D strut plates with conventional miniplates for the open reduction and internal fixation of mandibular fractures, with respect to postoperative infection, hardware failure, malocclusion, operating time, and other clinically relevant outcomes. Methods: A systematic search of PubMed/MEDLINE, Scopus, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science was performed for studies published between January 1995 and December 2024. Randomized controlled trials and prospective or retrospective comparative cohort studies enrolling at least five patients per arm and reporting outcomes for both 3D strut plate and conventional miniplate fixation of mandibular fractures were eligible. Two reviewers independently screened records, extracted data, and assessed risk of bias using the ROBINS-I tool. Random-effects meta-analyses (DerSimonian–Laird) were performed using odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). Heterogeneity was quantified by I² statistics and publication bias was evaluated using funnel plots and Egger's regression test. Results: Eighteen studies enrolling 1,196 patients (598 in the 3D plate group and 598 in the conventional miniplate group) were included in the qualitative synthesis; 14 contributed to the meta-analysis. The pooled analysis demonstrated a significantly lower odds of postoperative infection in the 3D plate group (OR 0.37, 95% CI 0.22–0.60; p < 0.001; I² = 0%), a lower odds of hardware failure or plate fracture (OR 0.28, 95% CI 0.15–0.53; p < 0.001; I² = 0%), and a non-significant trend toward less postoperative malocclusion (OR 0.60, 95% CI 0.34–1.03; p = 0.063; I² = 0%). Operating time was significantly reduced with 3D plates by a mean of 16.25 minutes (95% CI −18.38 to −14.12; p < 0.001; I² = 0%). The funnel plot for the infection outcome was symmetric and Egger's test was non-significant (p = 0.581), suggesting no substantial publication bias. Conclusions: Three-dimensional strut plates are associated with significantly lower rates of postoperative infection and hardware failure, and significantly shorter operative time, compared with conventional Champy miniplates for the treatment of mandibular fractures. The reduction in malocclusion did not reach statistical significance. The overall certainty of evidence is moderate, downgraded mainly because of the predominance of small, non-randomized comparative studies. Larger, well-designed randomized trials are needed to confirm these findings and to better characterize the role of 3D plates in specific fracture subtypes.