Does Open Reduction and Internal Fixation Yield Better Outcomes Over Closed Reduction of Mandibular Condylar Fractures?

Abstract

Despite decades of study, a consensus on therapeutic approaches to condylar fractures remains elusive, and the vexing question of invasive or noninvasive therapy remains to be definitively answered. This randomized clinical study aimed to compare the outcomes of mandibular condylar fractures (MCFs) treated by closed reduction (CR) with those treated by open reduction and internal fixation (ORIF). The investigators designed and implemented a randomized controlled trial composed of patients with unilateral or bilateral MCFs. Patients were randomly allocated into the ORIF and CR groups. The primary predictor variable was treatment, either CR or ORIF. The primary outcome variable was temporomandibular joint function (pain and range of motion) assessed at 1 and 6weeks and at 3, 6, and 12months. The secondary outcomes included occlusion and complications (deviation, facial nerve injury, and scarring). Perioperative covariates included fracture displacement, ramus height loss, and associated mandibular fractures. The effect of treatment group on each of the 12-month outcomes was assessed using the χ2 test or the independent samples t test. A 5% significance level was used. A total of 116 patients with MCFs were included in the study. Sixty-eight (59%) and 48 (41%) patients were treated by CR and ORIF, respectively. No statistically significant differences were observed between the 2 groups for mouth opening (P=.073, protrusion (P=.71), laterotrusive movements toward fractured side (0.080), and nonfractured side (P=.28). The median pain scores decreased from 4 (interquartile range [IQR] 3 to 4) at 6weeks to 0 (IQR 0 to 0) at 52weeks and 6 (IQR 5 to 6) at 6weeks to 0 (IQR 0 to 0) at 52weeks in the CR and ORIF groups, respectively. Statistically significant differences between the groups were observed for the outcome of malocclusion (P=.040) and deviation (P<.0001). Ramal height loss (P=.013) and angle of displacement (P=.0084) were significantly associated with the presence of complications in the CR group. The results of the present study have shown that both treatment options for MCFs yield acceptable results. However, CR yielded more complications, especially in patients with bilateral MCFs, ramus height loss greater than 5mm, and angle of displacement greater than 15°.