A Comparison of Outcomes and Complications Between Closed Reduction and Open Reduction of Mandibular Condylar and Subcondylar Fractures

Objective: To compare postoperative outcomes and complications between closed reduction and open reduction and internal fixation (ORIF) of condylar and subcondylar fractures. Methods: This is a multicenter, retrospective database study utilizing data from 64 healthcare organizations in the United States from January 1, 2010 to July 31, 2025. The TriNetX database was used to identify adult patients ages 18 years or older with a history of condylar or subcondylar fractures. These patients were either treated with closed reduction or ORIF. The relative risks (RRs) with 95% confidence intervals (CIs) for outcomes and complications were assessed within 1 year postoperatively. Results: Infection at or around the surgical site was more common with ORIF (RR: 0.64 [0.47-0.88]), while jaw pain and malocclusion were more frequent after closed reduction (RR: 1.73 [1.29-2.33]; 1.61 [1.21-2.15]). Malunion/nonunion and wound disruption rates were similar between groups (RR: 0.95 [0.61-1.48]; 1.33 [0.69-2.59]), and there were no facial nerve injuries. Patients treated with closed reduction had higher 30- and 90-day emergency department visit rates (RR: 1.90 [1.55-2.33]; 1.73 [1.44-2.09]). Conclusion: Closed reduction is associated with a higher rate of jaw pain, malocclusion, and visits to the emergency department when compared to ORIF, but associated with an increased risk of infection. There was no risk of facial nerve injury or osteomyelitis with either treatment options. Level of Evidence: 3.