Bone grafts versus titanium mesh implants in orbital fracture management: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis compares the effectiveness of bone grafts versus titanium mesh implants in managing orbital fractures, focusing on diplopia, enophthalmos, postoperative complications, and aesthetic outcomes.

METHODS

A systematic search of MEDLINE, EMBASE, CINAHL, and CENTRAL databases was conducted as per PRISMA guidelines. Studies directly comparing bone grafts and titanium mesh in orbital fracture management were included. Primary outcomes included diplopia, enophthalmos, complications. Aesthetic outcomes were qualitatively assessed. Meta-analyses were performed using fixed and random-effects models and risk of bias was evaluated using the ROBINS-I tool.

RESULTS

Eight studies involving 291 patients were included. No significant difference in diplopia incidence was observed between groups (OR: 1.87; 95% CI: 0.52-6.71; p = 0.34). Titanium mesh was associated with a significantly lower risk of enophthalmos (OR: 2.83; 95% CI: 1.19-6.75; p = 0.02). Complication rates were comparable (OR: 2.39; 95% CI: 0.55-10.35; p = 0.25). Aesthetic outcomes were favourable with both materials but insufficiently reported for meta-analysis.

CONCLUSION

Both bone grafts and titanium mesh implants are effective options for orbital fracture repair. Titanium mesh offers advantages in restoring orbital volume and preventing enophthalmos, supporting its preferential use in high-risk cases. Material selection should consider patient factors, defect characteristics, surgeon expertise and material availability.