Fracture fragment of the condyle determines the ramus height of the mandible in children with intracapsular condylar fractures treated conservatively.

This study aimed to explore and impart understanding of bone remodelling in children with intracapsular fractures treated conservatively. Records of children (less than 12 years), who sustained intracapsular fractures and treated conservatively, were retrieved consecutively for the period of March 2011 to February 2016. Data about age, gender, date of injury, dates of admission and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fractures, treatment methods and time of review were recorded and analysed. Image dates of pre- and post-treatments, including date of review, were also recorded. A total of 22 patients complete their follow-up and show bone remodelling process. During their follow-up, all the displaced condylar fragments fused with the ramus stump at the displaced position. Regardless of the type of conservative procedure, both treatments cannot promote the spontaneous fracture reduction in patients with intracapsular condylar fractures. During follow-up, the absorption of the lateral process of the condyle after the closed treatment becomes close to the 'horizontal absorption', until the height (or articular surface) of the lateral condylar process dropped and aligned to the articular surface of the medial process. In children with intracapsular condylar fractures, the fracture fragment of the condyle determines the ramus height of the mandible. Closed treatment cannot restore the fracture fragment. If the height of the fracture fragments dropped remarkably, then open reduction and rigid internal fixation become more suitable.

Removal of Fracture Fragments in Intracapsular Condylar Fractures: An Alternative Treatment Option.

OBJECTIVE: This study aimed to explore bone remodeling after condylar fracture fragments have been removed from patients with intracapsular condylar fractures. it also evaluated whether condyle fracture removal can be used alternatively when the authors treat patients with comminuted or small pieces of fracture or in extremely difficult operations. METHODS: Records of patients who sustained intracapsular condylar fractures and treated by removal of fragments for the period of February 2013 to September 2019 were retrieved. Data about age, gender, date of injury, dates of admission and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fracture, treatment methods and time of review were recorded and analyzed. Image dates of pre- and post-treatment (including the time of review) were also recorded. RESULTS: The data of a total of 103 patients ranging from 5 to 84 years old were retrieved during this study. A total of 135 sides of condylar fragments were removed. Almost all of the patients with comminuted condyle head fracture or type A fracture presented apparent shortening of the ramus height, and none of them showed osteogenesis (or new bone formation) during their follow-up. Present study only observed osteogenesis in few patients who sustained type B/C intracapsular condylar fractures during their follow-up. The younger the patient was, the longer the follow-up time was, and the higher the possibility of new bone formation was. No correlation was found between the amount of osteogenesis and follow-up time, the amount of osteogenesis was generally small, and no patient could form a new condyle head similar to the normal (or original) condyle head. Condylar hypertrophy only occurred in children. Four patients developed temporomandibular joint ankylosis. CONCLUSIONS: Removal of fracture fragments is an alternative treatment option for patients who sustained comminuted or small pieces of fracture or in extremely difficult operations.