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Relationship Between Intracapsular Fracture Patterns and Arthroscopic Findings
Ko Ito1, Fumie Yamazaki2, Kosuke Takahashi3
1Visiting Research Fellow, Oral and Maxillofacial Surgery Unit, Faculty of Health Science University of Adelaide, SA, Australia; Full-Time Lecturer, Department of Maxillofacial Surgery, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan.
Summary
Ultrathin arthroscopy in temporomandibular joint intracapsular condylar fractures reveals that displaced fragments lead to disc damage and fibrosis, potentially causing ankylosis. Non-displaced fractures heal normally.
Area of Science:
- Orthopedics
- Arthroscopy
- Temporomandibular Joint Disorders
Background:
- Intracapsular condylar fractures (ICFs) of the temporomandibular joint (TMJ) can lead to significant joint dysfunction.
- Understanding the intra-articular changes following ICFs is crucial for predicting clinical outcomes.
Purpose of the Study:
- To utilize ultrathin arthroscopy to examine the superior joint compartment (SJC) in patients with ICFs.
- To correlate fracture patterns and arthroscopic findings with clinical outcomes.
- To evaluate the healing process and potential complications like fibrosis and ankylosis.
Main Methods:
- Twenty patients with 27 ICFs underwent arthroscopic examination of the traumatized TMJ during definitive treatment.
- A secondary arthroscopy was performed at 4 months post-treatment.
- Range of motion (ROM) was measured, and fracture patterns were classified.
Main Results:
- Initial arthroscopy revealed hyperemia, hypervascularity, temporal bone damage, and disc perforations in some cases.
- At 4 months, minimally displaced fractures showed normal healing.
- Displaced minor fragments resulted in SJC filling, disc damage, and fibrosis, impacting ROM.
- Early definitive treatment positively influenced outcomes at 4 and 12 months.
Conclusions:
- The intra-articular condition 4 months post-ICF is strongly related to the position of the minor fracture fragment.
- Non-displaced fragments facilitate normal healing, while displaced fragments lead to SJC disc damage and fibrosis.
- Displaced fragments and subsequent fibrosis may result in fibrous ankylosis of the TMJ.
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