Use of Two Lag Screws for ORIF of Mandibular Condylar Sagittal Split fracture: An Anti-rotational Concept-A Prospective Clinical Trial.

Abstract

Condylar process fracture is one of the most common mandibular fractures. Approximately 11-16% of all facial fractures and 30-40% of all mandibular fractures are fractures of the mandibular condyle. Treatment can broadly be divided into open or closed, but there are no clear criteria to determine the choice between them. Sagittal split fracture of the mandibular condyle is rare and can be easily missed on conventional radiographs, like OPG and multiple standard films, but because of the high incidence of subsequent ankylosis is an important entity. So a CT scan with axial and coronal cuts is advisable in high condylar or intracapsular fractures of mandibular condyle. The hypothesis in this study is that open reduction and internal fixation (ORIF) of sagittal split mandibular condylar fractures with two lag screws is more stable and there is no rotation of the medial fractured segment of condyle. In this prospective clinical trial, ORIF of four patients with sagittal split fracture of mandibular condyle was done using two lag screws. In all the patients, pre-op and post-op clinical and radiological findings were evaluated, with a follow-up of two years. All the patients were evaluated postoperatively at periodical interval with various clinical parameters, viz. mouth opening, occlusion, pain, deviation of mandible while opening, other complaints (like clicking, tenderness), and radiologically with CT scans. All patients showed good occlusion and adequate mouth opening postoperatively. In this series, there was no pain, deviation of mandible while opening and other complaints like tenderness and clicking. In CT scan, the medial fragment was reduced anatomically in position and the lag screws were not protruding in the TM joint space. Use of two lag screws for ORIF of sagittal split mandibular condylar fractures is recommended to prevent the rotation of fractured medial condylar segment and for more stable fixation.