Comparative Evaluation of Open Reduction with Internal Fixation Against Closed Reduction Methods for Condylar...

Area of Science:

• Maxillofacial surgery
• Trauma surgery
• Orthopedic surgery

Background:

• Mandibular fractures, particularly condylar fractures (MCF), are common in facial trauma.
• Management strategies for MCF, including closed reduction (CR) and open reduction internal fixation (ORIF), are debated.
• Optimal treatment for MCF remains controversial in maxillofacial injury management.

Purpose of the Study:

• To systematically review literature and perform a meta-analysis comparing CR and ORIF for managing condylar fractures.
• To determine the superior treatment alternative for patients with condylar fractures.

Main Methods:

• Systematic review adhering to PRISMA guidelines, searching PubMed, Google Scholar, and Ebsco Host (2000-2021).
• Quality assessment using Newcastle-Ottawa Scale for cohort studies and Cochrane ROB-2 for randomized studies.
• Meta-analysis using standardized mean difference (SMD) with a random effect model; p < 0.05 considered significant.

Main Results:

• Seventeen studies were included; nine were suitable for meta-analysis.
• Pooled SMD favored CR over ORIF for maximum interincisal opening (SMD=0.80), laterotrusion (SMD=0.36), and protrusion (SMD=0.42).
• Significant heterogeneity and publication bias were noted in most analyses.

Conclusions:

• CR demonstrates superior functional outcomes compared to ORIF in managing condylar fractures.
• Further prospective randomized studies with controlled confounding factors are needed to unify clinical guidelines.
• CR is suggested as a potentially better treatment option for condylar fracture management based on current evidence.