INTRODUCTION

Condylar fractures account for one third of all mandibular fractures being in the range of 17.5–
52%1,2 of all mandibular fractures. They are usually caused by a force transmitted from chin
to the condylar process resulting in a fracture of the condylar neck in adults. 3 The most
common unilateral fracture is of sub-condyle, and the most common bilateral fracture occurs in
condylar heads4,mostly caused by direct trauma, but may also be due to indirect forces. Condylar
fractures are categorized into 2 groups: intra or extra-capsular fracture; this categorization is
based on the anatomical aspects such as the condylar head, condylar neck, and sub-condylar
region. Another classification method is based on the condyle position, i.e., undisplaced,
deviated, displaced (with medial or lateral overlap or complete separation), or dislocated (outside
the glenoid fossa) condyle fractures 5.The main goal in the treatment of condylar fractures is to
predictably restore pre-injury anatomical form, with associated aesthetics and function. The goal
must be accomplished by means that will produce the least disability, smallest risk, and shortest
recovery period for the patient. Different studies (Paydar et al., 1991; Sargent and Green, 1992;
Meijer et al., 1993; Throckmorton and Dechow, 1994; Meyer et al., 2002, 2006; Rallis et al.,
2003; Seemann et al., 2007) have highlighted that the concept of stable osteosynthesis is
correlated to the mechanical strains arising in the condylar region during mastication due to the
action of the muscles of mastication acting on the mandible.6 Meyer (Meyer et al., 2002), in
2002, highlighted the presence of compressive strains running along the posterior border of the
ramus and tensile strains positioned parallel to and below the sigmoid notch. The tensile strains
lines are mainly responsible for the complications concerning plate fracture or screw loosening7.
In the past various treatment modalities were used for open reduction and internal fixation
(ORIF) for condylar fractures which include Transosseous wiring, Lag screws, Champy’s mini-
plates, Dynamic compression plates, Eccentric dynamic compression plates (EDCP),3-D
miniplates like Trapezoidal condylar plates , delta plates and Bio-Resorbable miniplates8.9,10 But
there is still no consensus regarding the best choice of osteosynthesis devices to be used.

From a review of the literature (Ehrenfeld et al11, Undt et al12, Ellis et al 200013, Haug and Assael
200114, and Hyde et al15 2002, Wagner et al16 2002) it is evident that the technique used most
frequently for fixation is the positioning of a single miniplate, but this single plate is not capable
of resisting the biomechanical strains that occur in the condylar region during mastication. Many
authors have reported evidence of the high failure rate associated with positioning of a single
plate technique accounting up to 35% due to plate fracture, screw loosening and structural
instability. The main explanation for this is that this technique does not comply with the
osteosynthesis principles regarding functional stability.17

N o w lately more authors have reported significantly better results with the use of two
2.0mm miniplates in combination i.e. the first being placed in the axis of the condylar neck as
usual, the second being placed obliquely under the mandibular notch. This is in agreement with
Champy’s concept of stable osteosynthesis functionality (Champy and Lodde, 1976).18 Two-
plate fixation met with the fulfillment of dynamic osteosynthesis, but adaptation of 2 miniplates
in the region of condylar axis is difficult due to the constriction of condylar neck. 19 In the
condylar neck, the amount of bone is not always adequate to permit placement of 2–3 screws per
fragment, leading to the development of 3D plates. The 3-dimensional osteosynthesis plates were
introduced into maxillofacial surgery in the early 1990s developed by Farmand. 20,21,22

TCP is placed with one arm parallel to the condylar axis and second arm parallel to the
mandibular notch. Infection rate is less because of the reduced hardware and requires reduced
exposure as compared to 2–4 hole straight miniplates.23 so it can be effectively used as an
alternative to the modified 2-miniplate technique.

Now in recent past newer plating systems like the Delta plate, Lambda plate and Resorbable
plates have also been introduced and used in various studies for open reduction and internal
fixation of subcondylar fractures with their own share of advantages and disadvantages.

As till date no such comparative study has been done to assess the efficacy and stability of single
3-D trapezoidal condylar plate with single 2.0mm conventional miniplate in the ORIF of
mandibular sub-condylar fractures, henceforth there was a need to carry out such study.

The aim of this study is to compare and evaluate the clinical and radiographical results obtained
from patients where trapezoidal condylar plates (TCP) were used with those obtained by using
conventional miniplates in the stabilization of sub-condylar fractures of the mandible.