Resorbable fixation offers lower plate removal odds than titanium in pediatric facial fracturesResorbable Fixation Systems May Reduce Plate Removal for Facial Fractures

Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery Published September 3, 2026 Study authors: Kaur Kanwalpreet, Quadri Syed Altafuddin, Saini Ravinder S, Vaddamanu Sunil Kumar, Alarcón-Sánchez M… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider resorbable fixation for pediatric facial fractures; it may reduce need for plate removal, but weigh individual factors.

This meta-analysis evaluated resorbable fixation systems versus titanium fixation for managing facial fractures in patients aged 18 years or younger. The analysis pooled data from multiple studies, focusing on outcomes such as infection, malocclusion, implant palpability, and the need for plate removal. The authors observed that resorbable systems were associated with a substantial reduction in the odds of plate removal compared with titanium fixation, suggesting a potential advantage in avoiding a second operation for hardware removal.

Rates of infection, malocclusion, and implant palpability were reported in a minority of cases, indicating that resorbable fixation is generally well tolerated in this population. However, these figures are pooled estimates from a meta-analysis, and the authors did not report specific limitations or certainty assessments. The absence of reported follow-up durations and detailed patient characteristics limits the ability to draw firm conclusions about long-term outcomes.

Clinically, resorbable fixation systems appear to be a safe and functionally effective alternative to titanium plates for pediatric facial fractures, particularly as they accommodate facial growth. The reduced odds of plate removal may translate into fewer secondary procedures. Nevertheless, the decision should be individualized, considering fracture location, stability requirements, and patient-specific factors. Further comparative research with longer follow-up is needed to confirm these findings and refine patient selection.

A meta-analysis of 26 studies looked at how different materials work to fix facial fractures in children and adolescents. The study compared resorbable fixation systems to traditional titanium plates. These systems are designed to be absorbed by the body over time, which may help accommodate the natural growth of a child's face.

The findings showed that resorbable systems are safe and effective. The infection rate was 3.2%, and the rate of malocclusion was 8.7%. About 11.8% of patients experienced implant palpability. Most importantly, the study found a 96% reduction in the odds of needing to remove the plates compared to those who received titanium plates.

Because these materials are designed to be absorbed, they may be a practical choice for younger patients. However, these results are based on pooled data from multiple studies. You should talk to a specialist to determine which fixation method is best for a specific injury and the needs of a growing child.

What this means for you:

Resorbable systems may reduce the need for follow-up surgery to remove plates in children with facial fractures.

Common questions

Are resorbable fixation systems safe for children's facial fractures?

Yes, the study suggests these systems are safe and effective. The reported infection rate was 3.2%, and the rate of malocclusion was 8.7%. These systems are considered a functional alternative to titanium because they can accommodate the growth of a child's face.

Do children need fewer follow-up surgeries with resorbable plates?

The study found a 96% reduction in the odds of needing to remove a plate compared to using titanium. This suggests that resorbable systems may significantly decrease the need for additional surgeries to remove hardware after a facial fracture.

What are the potential side effects of these fixation systems?

The study reported a 3.2% infection rate and an 8.7% malocclusion rate. Additionally, 11.8% of patients experienced implant palpability. You should discuss these specific risks and your child's needs with a medical professional.

Study Details

Study typeMeta analysis

Sample sizen = 620

EvidenceLevel 1

Follow-up216.0 mo

PublishedSep 2026

PMID42250415

View Original Abstract ↓

The management of facial fractures in the pediatric population represents a unique challenge in facial fracture care, where fixation must strike a balance between stability and interference with growth and the need for secondary implant removal procedures. Bioresorbable fixation systems have been increasingly applied in this population; however, their pooled safety and performance data and clinical advantages over titanium fixation in the pediatric population are not well described. This systematic review and meta-analysis aimed to comprehensively assess the clinical outcomes and complication rates associated with the use of resorbable fixation systems in the management of pediatric facial fractures. The PubMed, Cochrane Library, Scopus, Web of Science, and ScienceDirect databases were searched for articles published until March 2025. The selection criteria were as follows: randomized controlled trials (RCTs), cohort studies, and comparative clinical studies of patients aged ≤18 years who received resorbable fixation systems for any facial fracture. The primary outcomes were infection, malocclusion, implant palpability, and plate removals. Study quality was assessed using the ROBINS-I risk of bias tool. A meta-analysis was conducted using a random-effects model and reported as log OR and logit event rate with 95% CI. Twenty-six studies reporting on nearly 620 patients were included in this review. The pooled infection rate was 3.2% (95% CI: 0.63-7.5%; I = 0%), malocclusion rate was 8.7% (95% CI: 1.88-15.7%; I = 0%), and implant palpability was observed in 11.8% of patients (95% CI: 6.42-17.2%; I = 0%). Compared with titanium fixation, resorbable systems were associated with a 96% reduction in the odds of plate removal (log OR: -3.287; 95% CI: -4.968 to -1.607; p = 0.00013). Statistical heterogeneity was low for all outcomes (I < 20%). No evidence of a significant publication bias was found. Resorbable fixation systems are safe, functionally effective, and growth-accommodating alternatives to titanium plates for managing facial fractures in children and adolescents. The greatly reduced risk of requiring secondary implant removal and low complication rates support their use as a first-line fixation strategy for facial fractures in the pediatric population.

Resorbable fixation offers lower plate removal odds than titanium in pediatric facial fracturesResorbable Fixation Systems May Reduce Plate Removal for Facial Fractures

Common questions

Study Details

Low-intensity pulsed ultrasound shows a 0.79 healing rate in nonunion fractures across observational studies

Trial results show mixed success for ultrasound on nonunion fractures

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Resorbable fixation offers lower plate removal odds than titanium in pediatric facial fracturesResorbable Fixation Systems May Reduce Plate Removal for Facial Fractures

Common questions

Study Details

Low-intensity pulsed ultrasound shows a 0.79 healing rate in nonunion fractures across observational studies

Trial results show mixed success for ultrasound on nonunion fractures

Clinical research that matters. Delivered to your inbox.

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