[Treatment of condylar fractures by anatomic reduction and rigid fixation with mini-plates]

To evaluate open reduction and miniplate rigid fixation for condylar fractures.

Ninety-seven condylar fractures (unilateral 47, bilateral 25) in 72 consecutive patients were studied. In them, 12 were old fractures, 81 were condylar neck and subcondylar fractures, 90 displaced or dislocated. Eighty-nine fractures were treated by operation, including removal of 7 broken condyles, reduction for 6 condyles with the aid of ramus osteotomy and directed anatomical reduction for 76 condyles. Fifty-nine fractures were fixed with a single miniplate, 21 with a double miniplates and 2 only with screws. Sixty-eight fractures were approached by retromandibular incision and 21 by periarticular incision. Postoperative follow-up period was 1 to 3 months in 9 cases, 3 to 6 months in 36 cases and 27 cases over 6 months, all cases were radiologically and clinically examinted to confirm the post-operative position of reduced fragment and complications secondary to operation.

There were 2 wound infection, 2 malocclusion, 2 nonunion, 3 plate fracture, 2 plate deformity, 7 inaccurate reduction, 6 fractured bone absorption, 7 mouth open, 5 TMJ chronic pain, 9 facial nerve damages, all above accounted 33% morbidity; however 91% (70/77) severely displaced or dislocated condylar neck and subcondylar fractures got accurate reduction and satisfactory final outcomes.

Miniplate rigid fixation based on anatomical reduction is an effective procedure in limitation of treating severely displaced or dislocated condylar neck and subcondylar fractures, biomechanical placement of plate is very important in successful application of this technique.