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Posteromedial dislocation of the elbow is a rare entity even exceptional if associated with a lateral condylar fracture. Very few isolated cases are reported in the English literature. We report an additional case of a 14-year-old child admitted for elbow trauma during scholar sport and presented a posteromedial elbow dislocation associated with a fracture of the lateral humeral condyle. The surgical treatment was made by using 3 cortical screws. The results were satisfying including range motion and he has resumed sports activities at 5 months. Elbow dislocation is a rare affection in children. It represents 3% to 6% of elbow injuries. The association of posteromedial elbow dislocation with a Milch type I is remarkably rare. We review the mechanism, classifications, and therapeutic modalities of this injury. Elbow dislocations associated with a lateral condylar fracture are exceptional and need an early reduction followed by an anatomical internal fixation to ensure articular congruity.

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Dislocation of the mandibular condyle of the temporomandibular joint (TMJ) is defined as a clinical condition in which head of the condyle is displaced out of its functional position within the glenoid fossa and posterior slope of the articular eminence Allen and Young in Br J Oral Surg 7:24-30, (1969). Dislocation of the mandibular condyle most commonly occurs in the anterior or anteromedial direction in both traumatic and non-traumatic origin dislocations. Lateral dislocations are generally rare owing to the thickening of the lateral surface of the articular capsule by the lateral ligament that strengthens the lateral surface of the joint Lovely and Copeland in J Can Dent Assoc 47:179-184, (1981). Trauma-induced dislocation of mandibular condyles is generally associated with a co-existing fracture of the condylar head, neck, or subcondylar region. Dislocation of the intact mandibular condyle in the superolateral direction is rare; if it occurs, it is difficult to reduce by closed reduction method. Present, this is a case report of rare bilateral superolateral dislocation of intact condyle associated with fractured mandibular symphysis region which was successfully managed through an open approach after failed attempts of closed reduction under local anaesthesia and general anaesthesia.

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BACKGROUND: Patients presenting with partially impacted lower third molars (M3) have a higher likelihood of experiencing angle fractures while simultaneously decreasing the risk of condylar fractures. However, the specific biomechanical mechanism responsible for this occurrence remains unclear. Moreover, there is an ongoing debate regarding whether the removal of M3s might actually increase the risk of condylar fractures. This study aimed to evaluate how the presence of M3s influences mandibular fractures resulting from blows to the symphysis and lateral mandibular body, and to determine the indication for extracting M3s in such cases. METHODS: Models of the mandible with a partially M3-impacted model (M3I), M3-extracted model (M3E), and M3-absent model (M3A) were generated using a computer. A traumatic blown force of 2000 N was applied to the symphysis and the right body of the mandible. Von Mises and principal stresses were analyzed, and failure indexes were determined. Two cases of mandibular linear fractures were chosen for model verification and interpretation. RESULTS: When force was applied to the symphysis, the condylar region exhibited the highest stress levels, while stress in the mandibular angle region was much less regardless of the M3 state. On applying the force to the right mandibular body, stress in the condylar region decreased while stress in the mandibular body increased, especially in the blown regions. Impacted tooth or cavity formation post-M3 extraction led to uneven stress distribution on the blown side of the mandible, increasing the risk of mandibular angle fractures. In cases where M3 was absent or the extraction socket had healed, stress from lateral traumatic blown force was evenly distributed along both the inner and outer oblique lines of the mandible, thereby reducing the risk of mandibular fractures. CONCLUSIONS: The reduced risk of condylar fractures in patients with partially impacted lower M3s and mandibular angle fractures is mainly due to lateral blows on the mandible, which generate less stress in the condylar region than blows on the mandibular symphysis, rather than being caused by the M3 itself. Extraction of the lower M3 can decrease the risk of mandibular fractures, with a minor influence on condylar fractures.

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Pediatric elbow fractures and dislocations have always been a challenge from a diagnostic and therapeutic point of view, primarily due to the complex nature of the pediatric elbow, especially its developmental anatomy. They must be diagnosed and treated on time to prevent numerous complications with long-term consequences. With the development of radiology and pediatric surgery and orthopedics, as well as the development of modern osteosynthesis materials, concerning current scientific and professional knowledge, the outcomes are getting better, with fewer acute and chronic complications. This comprehensive review aims to provide clinicians current knowledge about pediatric elbow fractures and dislocations so that in daily practice they have as few doubts as possible with the best possible treatment outcomes.

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The purpose of this retrospective study was to identify risks of postoperative facial nerve injury (FNI) in mandibular condylar fractures. A total of 59 consecutive cases of condyle fracture or plate removal with a retromandibular transparotid approach (RMTA) were divided into FNI and non-FNI groups that were evaluated for associations with age, sex, laterality, fracture type, height, weight, body mass index (BMI), and maxillofacial bone height and width diameters on computed tomography (CT). FNI occurred in 11 of 59 patients (18.64%), all of them female (p = 0.0011). Other statistically significant factors on univariate analysis for FNI included a short height (156.95 ± 8.16 cm vs. 164.29 ± 9.89 cm, p = 0.04), low weight (46.08 ± 8.03 kg vs. 58.94 ± 11.79 kg, p = 0.003), low BMI (18.64 ± 2.63 kg/m2 21.68 ± 3.02 kg/m2, p = 0.007), short condylion-anterior fracture distance (19.34 ± 3.15 mm vs. 22.26 ± 3.96 mm, p = 0.04) and short condylion-posterior fracture distance (20.12 ± 3.98 mm vs. 25.45 ± 5.02 mm, p = 0.009). Our retrospective study suggested that FNI with RMTA surgery occurs particularly in female patients and may occur more frequently in patients who are short, lean or have high condyle fractures.

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Las fracturas condilares continúan siendo un desafío para los cirujanos maxilofaciales, debido a los múltiples tipos de fracturas que pueden ocurrir y los tratamientos disponibles. El tratamiento de este tipo de fractura podría dificultarse si el paciente presenta edentulismo. Así, entre las opciones de tratamiento, el uso de una férula o la prótesis dental preexistente como medio de fijación se muestra como una opción viable. Se presentan 02 casos clínicos de pacientes masculinos de 36 y 83 años de edad que presentan un maxilar edéntulo y fracturande cóndilo mandibular de lado derecho; para su tratamiento se utilizó una férula de Gunning superior con fijación intermaxilar mediante el uso de tornillos de fijación intermaxilar y elásticos intermaxilares durante 4 semanas. Después de 3 meses de evolución, ambos pacientes presentaron una adecuada apertura bucal, sin desviaciones o limitación a la apertura bucal. Las férulas de Gunning, a pesar que actualmente son poco usadas, continúan siendo una opción apropiada para los casos de fractura del cóndilo mandibular en pacientes edéntulos.

Condylar fractures continue to be a challenge for maxillofacial surgeons, due to the multiple types of fractures that can occur and the treatments available. Treatment of this type of fracture could be difficult if the patient has edentulism. Thus, among the treatment options, the use of a splint or the pre-existing dental prosthesis as a means of fixation appears to be a viable option. Two clinical cases are presented of male patients aged 36 and 83 years who present an edentulous maxilla and fracture of the mandibular condyle on the right side; For treatment, an upper Gunning splint with intermaxillary fixation was used through the use of intermaxillary fixation screws and intermaxillary elastics for 4 weeks. After 3 months of evolution, both patients presented adequate mouth opening, without deviations or limitations to mouth opening. Gunning splints, although they are currently rarely used, continue to be an appropriate option for cases of fracture of the mandibular condyle in edentulous patients.

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The supracondylar fracture of the child is a common fracture. Its physiology, physiopathology and treatment use periosteum. As far as we know, there is no 3D printed model of this typical fracture in children with periosteum. The purposes of the research are to present the concept of an educational 3D printed supra condylar model with periosteum of the child and its expert validation. Materials and methods: The basis for the paediatric elbow model was a 3D scan of a four-year-old girl. Once the data had been extracted, the models were constructed using 3D Slicer®, Autodesk fusion 360® and Ultimaker Cura® software's. The Creality 3D Ender 6 SE Printer® used PLA filaments to print bone and TPU for periosteum. Printing took place at the University Hospital and the steps were modelled by hand. 3D printed bones and 3D printed periosteum were manually assembled. Participants: Expert validation with twelve paediatric orthopaedic surgeons took place in three University hospitals of the North of France. Results: Four Lagrange and Rigault 3D printed models of supracondylar fractures with periosteum were obtained with 200 h of design, printing and manual assembly based on a four-year-old elbow. According to the paediatric orthopaedic surgery experts, the size of the model is very good, but the model itself is of little interest compared to the information provided by the reconstruction of a 3D scanner. In total, with 9 out of 12 questions scoring higher than 8/10, the model was considered to be a good model for informing parents and teaching students. Conclusions: This study details the design of the first 3D-printed supra condylar fracture model in children with a full-size physeal and periosteum. The model has been validated by paediatric orthopaedic surgery experts.

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Background: The aim of this study is to assess patients' subjective perception of treatment outcome after extracapsular fractures of the mandibular condyle. Methods: A questionnaire survey regarding facial nerve palsy (FNP), malocclusion, pain, reduction in maximum mouth opening (MMO) and further discomfort after 3, 6, and 12 months was carried out. Patients aged 18 or more presenting with an extracapsular condylar fracture between 2006 and 2020 were identified by purposive sampling Questionnaires were received from 115 patients. Fractures were classified on the basis of the pre-treatment imaging, the way of treatment was obtained from patients' medical records. Data were analyzed using Pearsons' chi-square-test, descriptive statistics and Student's t-test. Results: 93.0% of the fractures were treated by open reduction and internal fixation (ORIF). MMO reduction was the most common post-treatment complication (55.6%). ORIF was associated with less pain after 3 months (p = 0.048) and lower VAS scores compared to conservative treatment (p = 0.039). Comminuted fractures were more frequently associated with post-treatment malocclusion (p = 0.048), FNP (p = 0.016) and MMO reduction (p = 0.001). Bilateral fractures were significantly accompanied by malocclusion (p = 0.029), MMO reduction (p = 0.038) and pain occurrence (p < 0.001). Conclusions: Patients report less pain after ORIF. Comminuted and bilateral fractures seem to be major risk factors for complications. Subjective perception of complications after extracapsular condylar fractures differs from objectively assessed data.

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Purpose: To study the incidence of sialocele formation in the parotid gland and to study the incidence of facial nerve affliction following treatment of mandibular condylar and sub-condylar fractures. Materials and methods: The present study is a retrospective study conducted on a total of 82 patients with 107 sub-condylar and condylar fractures treated in this centre from August 2008 to August 2020. The surgical approaches used to treat the fractures were considered, and the occurrence of sialocele, salivary fistula and facial nerve paralysis was noted. The facial nerve function was analysed using House-Brackmann system of classification. Results: The incidence of sialocele formation was seen in 15.87% of cases, and the incidence was seen more commonly during a preauricular approach (52.94%) followed by retromandibular (41.17%) followed by anterior parotid transmassetric approach (11.76%). The incidence of facial nerve affliction was seen in 17.57% of cases with majority of them showing temporal branch involvement in 21.05% of cases. Conclusion: During the treatment of condylar and sub-condylar fractures, the facial nerve is at considerable risk of damage; however, understanding the anatomy of the nerve is of importance to avoid such complications. Sialocele formation is also an undesirable complication of such surgeries, a prompt diagnosis and early treatment is mandatory to overcome further unwanted sequel.

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Background: Interventions using ultrasound-guided closed reduction and percutaneous pinning (UG-CRPP) of humeral lateral condylar fractures (HLCFs) have been increasingly applied; however, their effectiveness for unstable HLCFs and the criteria for ultrasound outcomes remain unclear. This study assessed the outcomes of UG-CRPP for HLCFs and evaluated the success criteria in children. Methods: Data were retrospectively collected from 106 patients with unstable HLCFs admitted to three hospitals between January 2021 and August 2022. Fifty-five cases were left-sided and 51 cases were right-sided: 74 male patients and 32 female patients were included. Perioperative data, elbow function, complications, and criteria for UG-CRPP were analyzed. Results: The mean rate of UG-CRPP was 88%. The mean surgical time was 54.56 ± 21.07 min, and the mean fluoroscopy frequency was 9.25 ± 2.93 times. At the last follow-up, there were significant differences in elbow flexion between the affected side (135.82° ± 6.92°) and the unaffected side (140.58° ± 5.85°) (p = 0.01). The Mayo score of the affected side was 90.28° ± 4.97°, the Baumann angle was 71.4° ± 5.4°, condylar shaft angle was 39.9° ± 6.4°, and the carrying angle was 8.4° ± 3.6°. Seventy patients presented mild lateral spurs and 16 patients exhibited moderate spurs. Fourteen patients presented with pin infection, and one patient exhibited postoperative re-displacement. There was no premature physeal closure, varus, or valgus elbow deformity, delayed union, or non-union. Successful ultrasound-based outcome criteria for UG-CRPP were defined as follows: (i) absent or less than a cartilage thickness step on the cartilage hinge on coronal plane parallel articular surface scanning, (ii) no lateral displacement and intact distal end of the condylar and capitellum on coronal plane vertical articular surface scanning, (iii) no anteroposterior displacement and absent or less than a cartilage thickness step on sagittal plane vertical articular surface scanning, and (iv) intact posterior fracture line or less than a cortex step on posterolateral sagittal plane vertical articular surface scanning. Conclusion: UG-CRPP is a procedure with minimal blood loss, less invasive, cosmetic, and no radiation exposure. It yielded good outcomes in unstable HLCFs. The successful criteria make it suitable for clinical application.

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OBJECTIVE: This study was conducted with the aim to establish standard technique of closed reduction (CR) and compare functional outcomes in patients of moderately displaced unilateral extracapsular condylar fractures. MATERIAL AND METHODS: This study is a retrospective randomized controlled trial, conducted at a tertiary care hospital setting from August, 2013 to November, 2018. Patients of unilateral extracapsular condylar fractures with ramus shortening < 7mm and deviation < 35° were divided in two groups by drawing lots and were treated by dynamic elastic therapy and maxillomandibular fixation (MMF). Mean and standard deviation were calculated for quantitative variables, and one way analysis of variance (ANOVA) and Pearson's Chi-square test were used to determine significance of outcomes between two modalities of CR. P value < 0.05 was taken as significant. RESULTS: The numbers of patients treated by dynamic elastic therapy and MMF were 76 (38 in each group). Out of which 48 (63.15%) were male and 28 (36.84%) were female. The ratio of male to female was 1.7:1. The mean ± standard deviation (SD) of age was 32 ± 9.57 years. In patients treated by dynamic elastic therapy, the mean ± SD (at 6-month follow-up) of loss of ramus height (LRH), maximum incisal opening (MIO) and opening deviation were 4.6mm ± 1.08mm, 40.4mm ± 1.57mm and 1.1mm ± 0.87mm respectively. Whereas, LRH, MIO and opening deviation were 4.6mm ± 0.85mm, 40.4mm ± 2.37mm and 0.8mm ± 0.63mm respectively by MMF therapy. One-way ANOVA was statistically insignificant (P value > 0.05) for above mentioned outcomes. Pre-traumatic occlusion was achieved in 89.47% of patients by MMF and in 86.84% patients by dynamic elastic therapy. Pearson's Chi-square test was statistically insignificant (p value < 0.05) for occlusion. CONCLUSION: Parallel results were obtained for both modalities; thus, the technique as dynamic elastic therapy, which promotes early mobilization and functional rehabilitation, can be favored as standard technique of closed reduction for moderately displaced extracapsular condylar fractures. This technique eases patients' stress associated with MMF and prevents ankylosis.

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PURPOSE: T-condylar (T-C) fractures of the distal humerus are rare in children. There is no accepted treatment for such an injury, and there is a lack of reports evaluating the outcome of T-C fractures treated by closed reduction and percutaneous fixation. The aim of this study was to evaluate the feasibility of closed reduction and percutaneous K-wire and screw (CRPKS) fixation in patients with type II and III T-C fractures according to the Toniolo-Wilkins classification modified by Canavese et al. (TWC classification). METHODS: The clinical data of 12 consecutive patients (8 males, 4 females) who were younger than 14 years of age and who had a T-C fracture that was managed by CRPKS were retrospectively evaluated. Fractures were classified according to the TWC classification. The baseline information of the patients, carrying angle (CA) and Mayo Elbow Performance Score (MEPS) were used to evaluate clinical and functional outcomes; related complications were recorded. Statistical analysis was performed. RESULTS: The mean age at the time of injury was 11.6 ± 1.8 years (range, 8-14). The time from injury to surgical treatment was 1.5 ± 1.0 days (range, 0-3), and the mean follow-up duration was 33.7 ± 12.3 months (range, 18-61). Surgery lasted 45.7 ± 7.6 min on average (range, 35-58). All fractures healed in 4.9 ± 1.0 weeks on average (range, 4-7). At the last follow-up visit, the CA was 12.6° ± 5.8° on the injured side and 13.8° ± 1.8° on the uninjured side (p=0.432). The MEPS was 100 (95, 100) on the injured side and 100 (100, 100) on the uninjured side (p=0.194). Three complications were recorded. CONCLUSION: Good functional and radiological outcomes can be expected in pediatric patients with type II and III T-C fractures treated by CRPKS. The technique is relatively simple to perform and has a lower rate of complications.

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The choices for managing a condylar head fracture (CHF) of the mandible are either open surgical or closed functional treatments (CFT) and the decision depends on various factors. The purpose of this systematic review was to ascertain from the available literature whether the open method or CFT yields better outcomes in managing CHF. We have systematically reviewed published articles according to the PRISMA statement. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library database for comparative studies about both open and closed treatments from inception until April 2023. The outcomes of interest were mouth opening (MO), protrusion, laterotrusion, postoperative pain, and malocclusion. Eight studies met the inclusion criteria. The review comprised of 326 cases, among which 177 were managed by open methods and 149 were treated by CFT. The incidence of postoperative malocclusion and pain were significantly less in the open group. MO was better in the open treatment group although this was not statistically significant. Protrusion and laterotrusion occurred slightly more in CFT, although these were also statistically not significant. Overall, meta-analysis favoured open methods of managing CHF. Although enough evidence exists for the use of open methods for selected condylar head fractures, CFT still demonstrated favourable outcomes in undisplaced fractures. The selection of a particular treatment method should be individualised on the basis of each particular case considering the risk/benefits. Further high quality randomised trials are needed to establish a therapeutic guideline.

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Fatigue-related subchondral bone injuries of the third metacarpal/metatarsal (McIII/MtIII) bones are common causes of wastage, and they are welfare concerns in racehorses. A better understanding of bone health and strength would improve animal welfare and be of benefit for the racing industry. The porosity index (PI) is an indirect measure of osseous pore size and number in bones, and it is therefore an interesting indicator of bone strength. MRI of compact bone using traditional methods, even with short echo times, fail to generate enough signal to assess bone architecture as water protons are tightly bound. Ultra-short echo time (UTE) sequences aim to increase the amount of signal detected in equine McIII/MtIII condyles. Cadaver specimens were imaged using a novel dual-echo UTE MRI technique, and PI was calculated and validated against quantitative CT-derived bone mineral density (BMD) measures. BMD and PI are inversely correlated in equine distal Mc/MtIII bone, with a weak mean r value of -0.29. There is a statistically significant difference in r values between the forelimbs and hindlimbs. Further work is needed to assess how correlation patterns behave in different areas of bone and to evaluate PI in horses with and without clinically relevant stress injuries.

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After a fracture of the condyle, the head of the condyle is often pulled inwards, which causes the fractured part to angulate medially. This change can cause a disbalance in the masticatory system. The disbalance could lead to contact stress differences within the temporomandibular joints (TMJs) which might induce remodelling within the TMJ to restore the balance. The contact stress in the fractured condyle during open and closing movements is expected to decrease, while the contact stress in the non-fractured condyle will increase. In a clinical situation this is hard to investigate. Therefore, a finite element model (FEM) was used. In the FEM a fractured right condyle with an angulation was induced, which was placed at different degrees, varying from 5° to 50° in steps of 5°. This study shows only minor differences in amount of contact stress between the fractured and the non-fractured condyle. The amount of contact stress in the condyles does not increase with a higher degree of angulation. However, with larger angulations, the contact stress within the fractured condyle is more centralized. Clinically, this more centralized area could be associated with complaints, such as pain. In conclusion, due to the more centralized contact stress in the fractured condyle, one would expect some minor remodelling on the fractured side with more angulation.

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This review analyzes muscle activity following mandibular condylar fracture (CF), with a focus on understanding the changes in masticatory muscles and temporomandibular joint (TMJ) functioning. MATERIALS AND METHODS: The review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A search was performed on online databases using the keywords "masticatory muscles" AND ("mandibular fracture" OR "condylar fracture"). The eligibility criteria included clinical trials involving human intervention and focusing on muscle activity following a condylar fracture. RESULTS: A total of 13 relevant studies were reviewed. Various studies evaluated muscle activity using clinical evaluation, bite force measurement, electromyography (EMG), magnetic sensors and radiological examinations to assess the impact of mandibular fractures on masticatory muscles. CONCLUSIONS: Mandibular condylar fractures can lead to significant changes in muscle activity, affecting mastication and TMJ functioning. EMG and computed tomography (CT) imaging play crucial roles in assessing muscle changes and adaptations following fractures, providing valuable information for treatment planning and post-fracture management. Further research is required to explore long-term outcomes and functional performance after oral motor rehabilitation in patients with facial fractures. Standardized classifications and treatment approaches may help improve the comparability of future studies in this field.

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OBJECTIVE: Premature dental contact on the fractured side and a contralateral open bite are signs of a unilaterally fractured condyle of the temporomandibular joint (TMJ). The lateral pterygoid muscle pulls the condyle inwards, causing angulation of the fractured part and shortening of the ramus. This imbalance after fracture might change the load in both TMJs and consequently induce remodeling. The present study aimed to calculate this change in load. It is hypothesized to decrease on the fractured side and increase on the non-fractured side. DESIGN: For these calculations, a finite element model (FEM) was used. In the FEM, shortening of the ramus varied from 2 mm to 16 mm; angulation, from 6.25° to 50°. RESULTS: After fracture, load on the non-fractured side increased, but only at maximal mouth opening (MMO). Simultaneously, load on the fractured side decreased, at both timepoints, i.e., MMO and closed mouth. When comparing all simulations at those time points, i.e., from 2 mm and 6.25° to 16 mm and 50°, the load in the fractured condyle declines steadily. However, for both timepoints, a threshold stands out around 6 mm shortening and 18.75° angulation: visualization of the fractured condyle showed, apart from load on the condylar head, a second point of load more medial in the TMJ which was most evident in the 6 mm - 18.75° simulation. CONCLUSIONS: These findings could implicate that the balance between both TMJs is more difficult to restore after a fracture with more than 6 mm shortening and more than 18.75° angulation.

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BACKGROUND/AIM: Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications. METHODS: A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis. RESULTS: The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009). CONCLUSION: Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.

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OBJECTIVES: After a fracture of the condyle, the fractured ramus is often shortened, which causes premature dental contact on the fractured side and a contralateral open bite. The imbalance could change the load in the temporomandibular joints (TMJs). This change could lead to remodelling of the TMJs to compensate for the imbalance in the masticatory system. The load in the non-fractured condyle is expected to increase, and the load in the fractured condyle to decrease. MATERIALS AND METHODS: These changes cannot be measured in a clinical situation. Therefore a finite element model (FEM) of the masticatory system was used. In the FEM a fractured right condyle with shortening of the ramus was induced, which varied from 2 to 16 mm. RESULTS: Results show that, with a larger shortening of the ramus, the load in the fractured condyle decreases and the load in the non-fractured condyle increases. In the fractured condyle during closed mouth a major descent in load, hence a cut-off point, was visible between a shortening of 6 mm and 8 mm. CONCLUSIONS: In conclusion, the change of load could be associated with remodelling on both condyles due to shortening of the ramus. CLINICAL RELEVANCE: The cut-off point implies that shortening over 6 mm could present more difficulty for the body to compensate.

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Objective: To compare the effectiveness and safety of closed reduction percutaneous pinning vs. open reduction with pin fixation to treat the pediatric humeral lateral condylar fracture. Methods: Studies comparing closed reduction percutaneous pinning vs. open reduction with pin fixation for treating pediatric lateral humeral condyle fractures were found by searching Pubmed, Embase, the Cochrane Library, and Web of Science databases, including randomized/non-randomized controlled, retrospective case-control, and prospective cohort studies. Furthermore, quality evaluation and data retrieval were conducted after the literature review. A meta-analysis was performed using RevMan 5.4 software to compare both groups' outcome measures. Results: This Meta-analysis incorporated eight studies with 856 cases. The Meta-analysis found no significant difference in functional outcomes, superficial infection, deep infection, poor fracture union, avascular necrosis of the humeral capitulum, or lateral spur formation between groups. However, the status of unaesthetic scars in the closed reduction percutaneous pinning group was superior. Conclusions: For pediatric humeral lateral condylar fracture surgical therapy, the efficacy and safety of closed reduction percutaneous pinning vs. open reduction with pin fixation were not significantly different; closed reduction percutaneous pinning offered the benefit of eliminating unaesthetic scar. However, further high-quality research is required to verify the conclusions of this Meta-analysis. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42023392451.