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 II: high condylar and condylar head fractures

Abstract

This study prospectively evaluated closed reduction (CR) outcomes in non-displaced, non-dislocated high-condylar and condylar-head fractures (Class VI after Spiessl and Schroll) and open reduction and internal fixation (ORIF) of displaced (Class III) or dislocated (Class V) fractures. Thirty-eight patients with 54 fractures (16 (42%) with bilateral fractures, 14 (37%) CR, 24 (63%) ORIF) were enrolled in a 1 year follow-up that 18 patients with 33 fractures completed. Condylar translation in Class VI fractures recovered to 11 mm for vertical opening, 8 mm for protrusion and 10 mm for mediotrusion; Class III synonymously 8 mm, 8 mm and 6 mm; and Class V 7 mm, 6 mm and 7 mm; incisal movements recovered to 38 mm, 8 mm and 8 mm in Class VI; 55 mm, 7 mm and 10 mm in Class III with 1 (8%) malocclusion, 1 (8%) impaired vertical opening and 55 mm, 7 mm and 9 mm in Class V with 2 (18%) malocclusions. Fragment-reduction versus the non-fractured condyle was −0.3 mm to +1.3 mm and +3° to +9° in Class VI, −1 mm to −0.2 mm and +3° to +2° in Class III, −3.3 mm to +3.1 mm and −11.2° to +1° in Class V. Malocclusion and joint locking were unreliable determinants for a treatment decision, being forged by concomitant fractures. Joint movements were within normal range at 1-year follow-up except Classes III and V vertical opening translation. After predefined criteria, 92% successful outcomes were attained. Multiple factor analysis should be used to prospectively evaluate the unacceptable clinical outcomes. Class VI fractures with intact vertical support should prospectively be evaluated whether these benefit from ORIF.