Clinical and safety outcome profiles of resorbable fixation systems in pediatric facial fractures: A systematic review and meta-analysis.

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%; I2 = 0%), malocclusion rate was 8.7% (95% CI: 1.88-15.7%; I2 = 0%), and implant palpability was observed in 11.8% of patients (95% CI: 6.42-17.2%; I2 = 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 (I2 < 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.