Conservative vs. Surgical Management of Condylar Fractures in Pediatric Populations: Complications and Factors for Consideration.

BACKGROUND

The optimal treatment decision for pediatric condylar fractures is influenced by various factors, including the child's age, fracture type, degree of displacement, and the presence of concomitant injuries. While non-surgical treatments are generally preferred due to high remodeling capacity in children, there remains a lack of comprehensive research comparing the long-term outcomes of open reduction internal fixation (ORIF) versus conservative management.

METHODS

Retrospective analysis of medical records of 71 pediatric patients (aged 0-18 years) treated for condylar fractures at the Department of Oral and Maxillofacial Surgery, Rambam Healthcare Campus, between 2010 and 2020 was completed. Gender, age, admission date, cause of injury, treatment methods, length of hospital stay, follow-up duration, and follow-up status were studied to help determine association with modality of treatment and complications.

RESULTS

No statistically significant differences were seen in complication rates across different age groups, genders, trauma etiologies, fracture sites (head/neck/base), laterality of fractures, nor was there an impact on choice of surgical vs. conservative intervention. Similar length of hospital stay was observed, even in cases with delayed surgical intervention. There was also no statistical significance of injury distribution based on socioeconomic standing.

CONCLUSIONS

Our research showed similar rates of complications in both surgically treated and conservatively treated cases. This solidifies the importance of practitioner experience, as well as comprehensive anamnesis to help caretakers most effectively determine the optimal treatment for each patient. As the surgical study group is substantially smaller than the conservatively treated group, large-scale prospective studies with extended follow-up will more conclusively help solidify results and establish guidelines.