Retrieval of the displaced condylar fragment with a screw: simple method of reduction and stabilisation of high and intracapsular condylar fractures

Abstract

We acknowledge the difficulties that arise when attempting to reduce and stabilise some condylar fractures, particularly those that are high or intracapsular. This paper highlights retrieval of the proximal fragment with a screw, and its benefit for reduction and stabilisation of the fractured condylar head before fixation. Eight patients with condylar fractures were treated at two centres, Morriston Hospital, Swansea, South Wales, and the General Hospital St. Jan, Brugge, Belgium between 1998 and 2007. The proximal fragment was retrieved by insertion of a screw in all cases. Three patients had unilateral, and five had bilateral high or intracapsular fractures. In all cases postoperative scans showed excellent anatomical repositioning and fixation of the condylar fragments. Postoperative follow-up showed good, stable occlusion, excellent mouth opening, and no facial nerve weakness even for a temporary period. Once the screw is in position the operator can gain precise control of the reduction, and the ease of manipulation reduces operating time considerably. The technique provides an excellent solution to the difficult task of reduction and stabilisation of the displaced fragment in condylar fractures, particularly in high fractures, and can be extended to other areas of maxillofacial trauma and corrective bone surgery.