Does Open Reduction and Internal Fixation Provide a Quality-of-Life Benefit Over Traditional Closed Reduction of Mandibular Condyle Fractures?

Abstract

This study sought to estimate patient-reported outcomes and compare quality-of-life (QOL) measures between patients electing for either open reduction internal fixation (ORIF) or closed reduction with intermaxillary fixation (CRIMF). This was a retrospective cohort study of patients with unilateral condyle fractures who had undergone either ORIF or CRIMF at the New York University Tisch Hospital and Bellevue Hospital Center. The primary study predictor was treatment choice (ORIF or CRIMF). Other study predictors were patient age, gender, and the presence of any other coexisting facial fractures. The 9 study outcomes were derived from an 11-item postoperative QOL questionnaire evaluating self-reported perceptions of pain and function. Univariate comparisons and multivariate regression models were calculated. A total of 38 patients (21 CRIMF and 17 ORIF) comprised the study sample. All patients were eligible for either ORIF or CRIMF, and the choice of treatment was decided through shared decision making after a comprehensive discussion of risks and benefits. With respect to pain outcomes, patients who underwent ORIF reported lower overall pain scores at 2weeks (P<.01) and 2months (P=.01), less mastication pain at 3months (P=.01), and a lower rate of persistent headaches after 6weeks (P=.04). With respect to functional outcomes, patients who underwent ORIF reported better range of motion at 3months (P=.01), less treatment-related weight loss (P=.01), and more ease when performing physical (P<.01) and work-related (P<.01) activities. In the multivariate regression models, ORIF was independently associated with decreased pain at 2weeks (P<.01) and decreased difficulty in obtaining nutrition (P<.01), performing physical activities (P=.02), and performing work-related activities (P<.01). Patients who underwent ORIF appeared to experience subjective favorable pain and functional QOL outcomes. Given the clinical controversy, the choice of treatment should synthesize patient-reported outcomes and be approached through shared decision making.