Risk Factors and Impact of Intra-Articular Scarring After Open Reduction and Internal Fixation in Mandibular Condylar Head Fractures-A Prospective Analysis.

Abstract

Background: During the routine removal of osteosynthesis materials after surgical treatment (ORIF) of condylar head fractures (CHFs), as performed at our clinic, localised and sometimes pronounced intra-articular scarring were observed quite regularly. This prospective study therefore investigates the causes of intra-articular scarring and its impact on functionality after surgical treatment (ORIF) of condylar head fractures (CHFs). Methods: Moreover, 80/98 patients with 96/114 CHFs (ORIF between 2014 and 2024) were evaluated when performing hardware removal. Statistical analysis used logistic regression and sign tests. Results: Postoperative scarring was seen in 72/96 cases (75%), either localised (n = 54; 56%) or pronounced (n = 18; 19%). Scarring correlated with limitations of laterotrusion for pronounced scarring (p = 0.016; OR = 6.806; 95% CI [1.422, 32.570]; large effect size) and with limitations of mediotrusion for localised scarring (p = 0.013; OR = 0.236; 95% CI [0.076, 0.734]; very small effect size). Factors favouring localised scarring were reduced ipsilateral dental support (p = 0.022; OR = 3.36; 95% CI [1.191, 9.459]; medium effect size) and major fragmentation (p = 0.029; OR = 3.182; 95% CI [1.123, 9.013]; medium effect size). However, there was no correlation between scarring and types (screws w/wo microplates) or number of osteosynthesis materials. Pronounced scarring showed a significantly higher risk for osseous degenerative complications (p = 0.041; OR = 4.171; CI [1.058, 16.452]; medium effect size). Conclusions: Intra-articular scarring after ORIF of CHFs poses a risk for functional limitations and osseous degenerative changes. Early adhesiolysis during the removal of hardware seems favourable for functional outcomes after CHFs.