Comparative effectiveness of one versus two miniplates in the management of mandibular angle fractures: a systematic review and meta-analysis.

Mandibular angle fractures constitute 20%-30% of mandibular fractures. The optimal fixation method remains debated, with some advocating a single non-compression miniplate for simplicity and others favouring two plates for stability. A PRISMA-compliant systematic review and meta-analysis (PROSPERO: CRD42024559840) was performed across PubMed, Scopus, Web of Science, and Cochrane CENTRAL up to July 2024. Eligible studies compared single versus dual miniplate fixation in adult isolated mandibular angle fractures. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using random-effects models. Sixteen studies (1,244 patients; 613 single-plate, 631 dual-plate) were included. Overall complication rates did not differ significantly (RR = 0.82; 95% CI: 0.66 to 1.02; p = 0.07). Single-plate fixation was associated with a lower risk of hardware complications (RR = 0.69; 95% CI: 0.51 to 0.95) and wound dehiscence (RR = 0.67; 95% CI: 0.45 to 0.99) compared with dual-plate fixation. Infection, malocclusion, neurosensory deficit, and reoperation rates were not significantly different. Single non-compression miniplate fixation appears preferable for most mandibular angle fractures, particularly when performed via a pure intraoral approach, and in favourable fracture patterns. Dual-plate fixation may still be considered in mechanically unfavourable fractures, but it carries higher hardware-related morbidity.