Clinical Evaluation And Analyze Of Open And Close Treatments On Pediatric Condylar Fractures

Part one:Epidemiological studies in children and adolescents fracture condylarObjective:Epidemiological analysis on condylar fractures in children and adolescents to understand the characteristics of the disease of condylar fractures in children and adolescents.Methods:Retrospective analysis a total of195cases of268lateral condylar fracture of patients under the age of18, statistical analysis the data of the age, sex, cause of injury of the patients, condylar fracture of unilateral or bilateral condylar fracture, the fracture fragments of the shift and so on.Results:195patients, male132cases, female64cases;42patients aged0-6years,7-12years58patients,95patients aged13-18; cause of his injuries were self-falls, falls injury, traffic accident, bicycle accident injuries, motorcycle accidents and other injuries;123cases of patients with unilateral condylar fracture, bilateral73cases; fracture site:PI lateral condylar fracture side number130, P2lateral condylar fracture of the number86side, P3lateral condylar fractures number31side, P4lateral condylar fractures number21side; degree of fracture displacement Dl condylar fracture side number21side, D2lateral condylar fracture side number101, D3lateral condylar fracture side number110, number36side condylar process fractures side D4:92lateral condylar fracture conservative therapy, surgical therapy172side.Conclusion:Children and adolescents condylar fracture patients with the most common male.13-18years of age is the highest risk age. cause of injury to themselves fall most common unilateral compared with bilateral multiple, the most common fracture site to PI. the shift the extent to D3is most common, most fractures treated by surgery method.Part two:The classification and choice of treatment on condylar fractures in children and adolescents Objective:To investigate the classification and choice of treatment methods of condylar fracture in children and adolescents. Methods:The clinical data of195patients under the age of18years old suffered268sides of condylar fractures were involved in this study. We classified these condylar fractures according to the age (A) of the patient, the displacement (D) and the position (P) of the fracture (ADP classification). We defined0-6years old as Al,7-12years old as A2,13-18years old as A3, no displacement of the fracture fragments as Dl, mild displacement as D2, severe displacement as D3, dislocation of the condylar as D4, the head of the condylar fractures as PI, the neck of the condylar as P2, under the condylar neck as P3, two or more parts fractures of condylar as P4. The following conditions including bilateral condylar fracture (B), midface fractures (M) and severe Malocclusion (Ma) were also under considering. These data were gathered and then classified into type I (A1D4P2-4, A2D3-4P1-4, A3D3-4P1-4, A3D1-2P1-4+B/M/Ma) which open treatment was recommended and type ? (A1D1-4P1, A1D1-3P2-4, A2D1-2P1-4, A3D1-2P1-4) which close treatment was recommended. All of the patients were asked to participate the follow-up visit for more then2years. The data of the patients'mouth opening, lateral movement, X-ray results and some others were collected during the return visit.Results:According to the ADP classification,171sides were defined as type I and97sides were defined as type ?. The recommended treatment methods were chosen in97.8%of the fractures. Satisfactory clinical results were obtained in both patients who chose open or close treatment at the2years later follow-up visit.Conclusion:Satisfactory clinical results were obtained on patients who treated by the guidance of the ADP classification. The ADP classification is an effective method on choosing proper treatment in children and adolescents who suffered condylar fractures. Part three:Clinical evaluation and analyze of open and close treatments on pediatric condylar fracturesObjective:The purpose of this retrospective study was to evaluate the long-term clinical and radiographic outcomes of open and close treated condylar fractures of mandible in children.Methods:78cases (29girls and49boys) were involved in this study and suffered from105mandibular condylar fractures. All patients (younger than12years at the time of injury) were followed at least3years. According to the classification of the condylar fractures, open or close treatment was chosen. Clinical outcomes were classified as favorable or unfavorable depending on the mouth opening, pattern of mouth opening, occlusion, facial symmetry. Condylar remodeling was defined as complete, moderate, or poor based on the radiographic findings.Results:Depending on the classification,14sides of type I,#8sides of type II and43sides of type ? were included in this study. Open treatment was chosen in51sides and close treatment was chosen in54sides. Most of the patients acquired satisfactory clinical outcomes. Better radiologic remodeling of the condylar process was found in the patients treated by open treatment. Conclusions:Favorable clinical long-term outcomes were obtained in both open and close treated mandibular condylar fractures. A better morphological remodeling of condylar process was found in patients with open treatment.