Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: a randomized, prospective, multicenter study with special evaluation of fracture level.
OBJECTIVE
This randomized, clinical multicenter trial investigated the treatment outcomes of displaced condylar fractures, and whether radiographic fracture level was a prognostic factor in therapeutic decision-making between open reduction and internal fixation (ORIF) versus closed reduction and mandibulomaxillary fixation (CRMMF).


METHODS
Sixty-six patients with 79 displaced fractures (deviation of 10 degrees to 45 degrees, or shortening of the ascending ramus >or=2 mm) of the condylar process of the mandible at 7 clinical centers were enrolled. Patients were randomly allocated to CRMMF (n = 30 patients) or ORIF (n = 36 patients) treatment. The following parameters were measured 6 months after the trauma. Clinical parameters included mouth opening, protrusion, and laterotrusion. Radiographic parameters included level of the fracture, deviation of the fragment, and shortening of the ascending ramus. Subjective parameters included pain (according to a visual analogue scale), discomfort, and subjective functional impairment with a mandibular functional impairment questionnaire.


RESULTS
The difference in average mouth opening was 12 mm (P <or= .001) between both treatment groups. The average pain level (visual analogue scale from 0 to 100) was 25 after CRMMF, and 1 after ORIF (P <or= .001). In 53 unilateral fractures, better functional results were observed for ORIF compared with CRMMF, irrespective of fracture level (condylar base, neck, or intracapsular head). Unexpectedly, the subjective discomfort level decreased with ascending level of the fracture. In patients with bilateral condylar fractures, ORIF was especially advantageous.


CONCLUSIONS
Fractures with a deviation of 10 degrees to 45 degrees, or a shortening of the ascending ramus >or=2 mm, should be treated with ORIF, irrespective of level of the fracture.
Schneider
Matthias
M
Department of Oral and Maxillofacial Surgery, Technical University of Dresden, Dresden, Germany. Matthias.Schneider@uniklinikumdresden.de
Erasmus
Francois
F
Gerlach
Klaus Louis
KL
Kuhlisch
Eberhard
E
Loukota
Richard A
RA
Rasse
Michael
M
Schubert
Johannes
J
Terheyden
Hendrik
H
Eckelt
Uwe
U
D003657:Decision Making; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006801:Humans; D019248:Jaw Fixation Techniques / Q000295:instrumentation*; D008335:Mandibular Condyle / Q000293:injuries* / Q000601:surgery; D008337:Mandibular Fractures / Q000473:pathology / Q000601:surgery*; D010149:Postoperative Pain; D011446:Prospective Studies; D016059:Range of Motion, Articular; D013704:Temporomandibular Joint / Q000293:injuries; D016896:Treatment Outcome