Association Between the Treatment Modality of Pediatric Subcondylar Fractures and Functional Outcomes at the Six-Month Follow-Up: A Retrospective Pilot Study

BACKGROUND: The choice of treatment for subcondylar fractures in children and adolescents remains a controversial issue. The aim of this study was to evaluate the association between the treatment modality of subcondylar fractures and functional outcomes at the six-month follow-up.

METHODS: This retrospective study examined a cohort of children and adolescents with unilateral or bilateral subcondylar fractures treated at a level 1 trauma center over a five-year period. Radiological assessments of ramal height shortening (RHS) and subcondylar fracture angulation (SFA) were conducted using cone beam computed tomography. A total of 28 patients met the inclusion criteria, which required participants to be 18 years of age or younger, have a follow-up period of at least six months, and present with an initial SFA of less than 45°. Subcondylar fractures were classified into three categories: Class I (RHS <2 mm and/or SFA <10°), Class II (RHS ≥2 mm and ≤15 mm and/or SFA ≥10° and ≤35°), and Class III (RHS >15 mm and/or SFA >35°). Functional outcomes, including maximal mouth opening, lateral movements, and protrusive movements, were assessed at the six-month follow-up. Reference values specific to children and adolescents were applied to distinguish between normal and limited mandibular motion. The relationship between treatment modality and functional outcomes was analyzed using logistic regression, with adjustments made for age, sex, and fracture classification. Results: Twenty-eight patients (67.9% male; mean age 14.0±4.0 years) met the inclusion criteria. Of these, 53.6% (n=15) were treated with open reduction and internal fixation, while 46.4% (n=13) underwent closed reduction. The choice of treatment modality significantly influenced patient prognosis. Closed reduction was strongly associated with improved functional outcomes, specifically in the vertical range of movement (odds ratio (OR)=16.4; P=0.047), lateral range of movement (OR=18.7; P=0.044), and overall combined functional outcomes of vertical, lateral, and protrusive movements (OR=10.9; P=0.028).

CONCLUSION: This preliminary study suggests a correlation between treatment modality and functional outcomes at the six-month follow-up. Open reduction and internal fixation of subcondylar fractures in children and adolescents may carry a higher risk of poor functional outcomes. The findings support closed reduction as the preferred approach for Class I-III cases with subcondylar fracture fragments angulated between 0° and 45°.