Surgical vs. nonsurgical treatment of intracapsular and high condylar fractures assessment of functional results with MRI and axiography

The aim of the present study was to evaluate the postoperative functional: outcome after open reduction of TMJ high condylar and intracapsular fractures with displacement by magnetic resonance imaging (MRI) and electronic axiography. 33 subjects with 41 condylar fractures (OT) were imaged postoperatively (mean 24 months) with a 1.5 Tesla system and registered by axiography. 16 nonsurgically treated fractures were assessed as a reference (NST). Results: 1) Surgically treated TMJs showed overall normal disc positions. In contrast, all conservatively treated high condylar fractures were malpositioned antero-medially. Nevertheless, both groups presented severe limitations of the axiographic tracings (30% of the subjects in OT, an subjects in NST with high condylar fractures). 2) Surgically treated high condylar fractures showed better condylar mobility (mean 6.3mm in OT vs. 4.2mm in NST) and a less marked reduction of vertical ramus height (mean 1.58mm in OT vs. 6.9mm in NST). 3) Significant correlations were found after operative treatment between fixed (proportional to =0.05) or highly immobilized (proportional to =0.01) discs and axiographic limitations, suggesting preservation of disc mobility to be of major importance. According to the functional results observed, fractures with displacement of disc and condyle in high condylar and intracapsular fractures will profit by open reduction and osteosynthesis.