Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures. Part I: condyle and subcondylar fractures

Abstract

This prospective study evaluated outcomes of closed reduction (CR) in non-displaced, non-dislocated condyle and subcondylar fractures (Class I) and open reduction and internal fixation (ORIF) of displaced (Class II) and dislocated (Class IV) fractures. Forty-five patients with 51 fractures (six (13%) with bilateral fractures), 11 (25%) CR and 34 (75%) ORIF, were enrolled in a 1-year follow up that 20 patients with 25 fractures completed. Condylar translation in Class I fractures recovered to 12mm for vertical opening, 9mm for protrusion, 8mm for mediotrusion; in Class II, respectively, 10, 7 and 9mm; and Class IV, respectively, 8, 7 and 7mm. Incisal movements recovered to 46, 8 and 9mm in Class I; 44, 7 and 9mm in Class II; and 43, 5 and 7mm in Class IV. Vertical and angular fragment reduction versus the non-fractured condyle was +0.3 to -1.9mm, +1.1 degrees to +1.8 degrees in Class I; -2.2 to -1.9mm, +0.6 degrees to -1.2 degrees in Class II; +2.9 to -1.1mm, +18.4 degrees to +6 degrees in Class IV. Malocclusion and joint locking were unreliable determinants for a treatment decision, being forged by concomitant fractures. All complications subsided after 6 months; translation and incisal movements returned to within the normal range in proportion to the severity of displacement and dislocation. Vertical opening translation in Class IV fractures remained short-to-normal and was compensated by rotation. Unacceptable clinical function according to predefined standards was not found after 1 year. Angular reposition was better than vertical reduction. This study documents successful evidence-based treatment according to predefined criteria.