Aetiology and Pattern of Mandibular Condylar Fractures: A Retrospective Cohort Study of 122 Patients
Conditions: Mandibular Fractures, Facial Injuries
Sponsor: Azita Sadeghzade

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           Study Protocol – Cover Page 
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Official Study Title: 
Aetiology and Pattern of Mandibular Condylar Fractures: 
A Retrospective Cohort Study of 122 Patients 
NCT Number: 
Pending 
Document Date: 
June 25, 2025 
 
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Aetiology and pattern of 122 patients with mandibular condylar 
fracture 
 

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Abstract: 
Objective: This research sought to examine the aetiology and pattern of Mandibular Condylar 
Fractures (MCF). 
Methods: Data on patients who had MCF from 2018 to 2020 were documented, including 
fracture aetiology, site, kind, fracture line angle, and concomitant injuries. The data were 
further analysed with the chi-square test, t-test, and ANOVA. 
Results: This research included 122 patients (94 men and 28 females), yielding a male-to-
female ratio of 3.35:1 and an average age of 30.7 years. Road traffic accidents was the 
predominant cause of fractures, accounting for 75.4%. Of the 153 fractures, 75 (49.01%) were 
categorised as subcondylar fractures, 69 (45.09%) as condylar neck fractures, and 9 (5.9%) as 
condylar head fractures. Among several forms of MCF, MacLennan class III was the most 
frequent (n=56, 36.6%), whereas MacLennan class I was the least common type of fracture 
(n=13, 8.5%). Moreover, symphysis and maxillary fractures were more prevalent in individuals 
with bilateral condylar fractures compared to those with unilateral condylar fractures (p=0.017 
and p=0.035, respectively). On the other hand, individuals who had unilateral condylar 
fractures were more likely to have mandibular body fractures than those who had bilateral 
condylar fractures (p = 0.015). In cases where the condylar neck and sub-condylar fractures 
were present, the average angle of the fracture line with the posterior border of the ramus was 
120.85 11.14 degrees. 
Conclusion: A motor traffic collision was the predominant aetiology of MCF. The findings 
indicated a substantial correlation between the severity of condylar fractures and the 
concomitant injuries. 
Keywords: Mandibular fracture, Mandibular angle, Unilateral, Bilateral, Trauma 
 
 
 

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Introduction 
Mandibular fractures are among the most prevalent injuries in individuals with craniofacial 
trauma (1). The prevalence of MCF has been reported as 29-52% of all mandibular fractures 
(2-6).  
A multitude of investigations has been conducted on the aetiology of condylar fractures. 
Silvennoinen et al (6) mentioned violence as the most common cause of these fractures. In 
other studies, falls were found to be the leading cause of condylar fractures in women and 
children (7, 8). Recent studies, however, have shown that Road Traffic Accidents (RTA) played 
a significant role in these fractures (4, 5, 9, 10).  
According to the anatomical level of fractures, there are three types of condylar fractures: the 
condylar head (intracapsular), the condylar neck, and the sub-condylar area (6, 11-13). Fracture 
displacement depends on the direction, degree, magnitude, and point of force application. 
Dentition and occlusion statuses are essential, as well (10). The fracture may be categorised as 
undisplaced, deviated, displaced (with medial or lateral overlap or total separation), and 
dislocated (external to the glenoid fossa) (14).  
Understanding the pattern of maxillofacial trauma can help determine preventive policies and 
evaluate treatment modalities (5). The current research is to ascertain the epidemiological 
features and incidence of mandibular condylar fractures within a specific group. More and 
more in-depth articles related to the proposed topic are given below for further reading: 
The (15) discusses the etiology, classification, clinical features, diagnosis, and management of 
mandibular condyle fractures. It highlights that these fractures account for 10-40% of 
mandibular trauma, with a higher incidence in children. Falls, incidents involving vehicles on 
the road, and injuries sustained in sports are all common causes. The chapter also covers 
treatment protocols for different age groups and the indications for closed versus open 
reduction. 
The study (16) analyzes the etiology of mandibular condylar fractures in a tertiary care setting. 
It found that falls (45.71%) and road traffic accidents (40%) were the predominant causes. The 

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study also noted a higher incidence of fractures in males, particularly in the third decade of life. 
Detailed radiological investigations were emphasized for accurate diagnosis. 
The article (17) studied the prevalence and causes of mandibular condyle fractures and 
documented that the majority of cases were due to motor vehicle accidents (44.20%) or cycling 
(24.61%). The authors also recognized the anatomical predisposition of the condylar region 
and the impact proper diagnosis (early and accurate) has on preventing complications.  
The article (18) provided information about the clinical presentation and causes of mandibular 
condylar fractures. The study noted accidents from road traffic or falls, and many cases 
involved young adults. Additionally, it highlighted the need to conduct both clinical and 
radiographic assessments (definitively including CBCT/CT) to facilitate reasonable treatment 
protocols.  
The third article (19) conducted a retrospective review of the patterns and causes of mandibular 
condylar fractures within a defined period. They also recognized interpersonal violence 
(assault, etc.) and sports as additional contributory factors to falls and motor vehicle accidents. 
They stressed that treatment should involve a multidisciplinary approach to aid in preventing 
long-term outcomes. 
The reference (20) provides an extensive summary of mandibular and midface fractures, 
examining the causes, clinical features, and diagnosis. It explains the need for dental X-rays 
and CT scans for accurate diagnosis. Most fractures of the mandibular condyle indeed occur 
from blunt trauma and commonly present with preauricular pain and restricted mouth opening. 
Various treatments are available for fracture repair, ranging from conservative therapy to 
surgical treatment, depending on the extent of the fracture and displacement. 
The article (21) provides a clear discussion of the causes of condylar fractures and their 
treatment. According to what is written in the article, the large majority of the time, condylar 
fractures are a result of blunt trauma to the anterior mandible, which transfers forces to the 
condylar area. The variable anatomy that limits posterior jaw mobility is examined concerning 

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the glenoid fossa, TMJ capsule, and lateral pterygoid. Management involved both open and 
closed reduction, with a significant emphasis on managing complications. 
The (22) discusses the etiology, clinical features, and management of mandibular condyle 
fractures. The authors discuss clinical controversies surrounding treatment options, particularly 
open versus closed reduction, but emphasize the importance of understanding the anatomy of 
the temporomandibular joint and the need for thorough clinical and radiographic examination. 
The chapter also describes complications and the role of physiotherapy in managing them. 
 
 
 

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Material/Subjects/Patients and methods 
The current study was approved by the Institutional Research Ethics Committee 
(IR.SUMS.DENTAL.REC.1399.120). The medical files of patients with facial trauma 
admitted to a trauma center were reviewed from January 2018 to December 2020. An 
investigator collated and normalized the information and data extracted from the medical files, 
clinical and radiographic exams, and patients' medical histories. In order to qualify for inclusion 
in the research, subjects had to have either unilateral or bilateral condylar fractures acquired 
from an external trauma. The exclusion criteria included incomplete information regarding the 
trauma in the medical records and a history of prior condylar fractures.  
The data relating to the aetiology, location, and type of the fracture, as well as the fracture line 
angle and the associated injuries, were collected. The patients were etiologically divided into 
three groups, i.e., RTA, falling, and violence (assault). The fractures were classified using 
Computed Tomography (CT) examinations. According to Loukota et al (23), the fractures were 
classified into three categories: sub-condylar, condylar head, and condylar neck fractures by 
taking into consideration the position of the fractures (Fig. 1).  
Moreover, based on MacLennan’s research  (14), fracture types were categorized into four 
subclasses according to the degree of displacement: 
1. Non-displaced 
2. Deviated 
3. The condylar head was still located inside the glenoid fossa, despite the fact that the 
proximal and distal fracture portions overlapped one another. 
4. The condylar head was dislocated, meaning that it was situated outside of the glenoid 
fossa (Fig 2). 
In addition, the injuries that were associated with the incident were classified as fractures of 
the mandibular bone (including the symphysis, body, angle, ramus, and coronoid), maxillary 

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bone, zygomatic bone, and nasal bone. The angle of the fracture line was evaluated in the 
sagittal view for cases with condylar neck and sub-condylar fractures (Fig. 3). 
 This evaluation was performed between the fracture line and the posterior border of the ramus 
where the fracture line was located. SPSS Statistics for Windows, version 23 (written by SPSS 
et al. in the United States), was used for each and every statistical analysis. The results of the 
descriptive analysis of the data were described using either the mean (standard deviation) or 
the frequency (percentage). In order to analyse the categorical variables, a chi-square test was 
carried out. These variables included age groups, sex, etiology, location of the fracture line, 
type of fracture, and associated injuries. 
The purpose of this test was to determine the strength of the correlation that existed between 
the variables that highlighted the categories. 
To establish if there was an association between the ages of the fractures and the causes of the 
fractures for both males and females, a t-test was performed. This was conducted to determine 
if a correlation existed. To establish the relationship between the mean angle of the fracture 
line and the etiology of the fracture, a statistical method called analysis of variance (ANOVA) 
was employed. This was to determine whether a connection existed and, finally, given the 
importance of the P-value being less than 0.05, to determine if the results were statistically 
significant. 
 
 

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Results: 
This study included a total sample of 122 participants, which included 94 males and 28 females. 
This resulted in a male-to-female ratio of 3.35:1. The mean age of patients in the cohort was 
30.70±11.39 years (range, 12 to 65 years). The breakdown of the number of sexes by age group 
is outlined in Table 1. The results of the chi-square test indicated an absence of a statistically 
significant correlation between age and sex distribution, with the majority of patients falling 
within the 21-30 age bracket (39.3%).  
Of the 122 patients diagnosed with MCF, 91 individuals, representing 74.6%, exhibited 
unilateral fractures, while 31 individuals, accounting for 25.4%, presented with bilateral 
fractures. Among the 153 condylar fractures, 79 occurred on the left condyle while 74 were 
observed on the right condyle. The predominant cause of MCF was RTA (n=92), succeeded 
by falls (n=22) and physical assault (n=8). When it came to the causes of fractures, the chi-
square test revealed that there was no statistically significant difference between the two sexes. 
This was the conclusion reached by the researchers. Furthermore, the t-test findings revealed 
no notable correlation between the aetiology of fractures and age across both genders (Table 
2).  
Among the various classifications of MCF, MacLennan class III emerged as the most prevalent, 
with a total of 56 instances, accounting for 36.6% of the cases. In contrast, MacLennan class I 
represented the least common type, with only 13 occurrences, which corresponds to 8.5%. The 
findings of the chi-square test suggested that there was no statistically significant correlation 
between the aetiology and the kind of fractures (p=0.706) (Table 3). This was the conclusion 
reached by the researchers. 
In light of the geographical context, the majority of fractures (n=75, 0%) were identified as 
subcondylar, succeeded by condylar neck fractures (n=69, 0%) and condylar head fractures 
(n=9, 0%). Table 3 displays the findings of the chi-square test, which indicated that there was 
no statistically significant correlation between the site of fractures and the aetiology of those 
fractures (p=0.292).  

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Table 4 indicates that 91 fractures, accounting for 74.6%, were unilateral, while 31 fractures, 
representing 25.4%, were bilateral. The results of the chi-square test indicated a noteworthy 
correlation between the aetiology of fractures and the severity of injuries, specifically in the 
context of unilateral and bilateral condylar fractures (p=0.071).  
The incidence of patients who experienced concomitant injuries alongside unilateral and 
bilateral condylar fractures has been enumerated and juxtaposed in Table 5. Consequently, the 
incidence of symphysis and maxillary fractures was notably higher in patients exhibiting 
bilateral condylar fractures compared to those with unilateral fractures (p=0.017 and p=0.035, 
respectively). In contrast, the incidence of mandibular body fractures was significantly greater 
in cases of unilateral fractures compared to those with bilateral condylar fractures (p = 0.015). 
This was true for both unilateral and bilateral fractures. When it came to the mandibular angle, 
there was a significant difference between individuals who had unilateral fractures and those 
who had bilateral fractures (p = 0.064). 
When it comes to cases involving condylar neck and sub-condylar fractures, the average angle 
of the fracture line in regard to the posterior border of the ramus was measured to be 120.85 
11.14 degrees. According to the findings of the analysis of variance, there was not a statistically 
significant connection between the aetiology of the fracture and the mean fracture line angle 
(p=0.711) (Table 6). This was the conclusion reached by scientists. 
 
 
 

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Discussion: 
Epidemiological studies of condylar fractures can effectively understand the pattern of these 
fractures and implement preventive policies (5). The present study on MCF indicated the most 
involved age groups, prevalence of different etiologies, locations, types of fracture, frequency 
of the patients sustaining the associated injuries, and the mean of fracture line angle.  
In the present study, the male/female ratio was 3.35:1, which was similar to that found in other 
studies (2, 3, 5, 6, 9, 10), but greater than the ratio reported by Marker et al (2:1) (4). 
Additionally, the mean age of the patients was 30.7 years, which was in agreement with the 
studies carried out by Silvennoinen et al (6), Marker et al (4), and Sawazaki et al (5). 
Furthermore, the 21-30 age group was more prone to condylar fractures, which was in line with 
the findings of other reports (5, 24). The current study findings revealed no significant 
relationship between age group and sex ratio. However, Zhou et al showed a decrease in the 
male/female ratio in the 11-20 age group compared to other age groups. This may be because 
women in the 11-20 age group play active societal roles. Besides, around the age of puberty, 
they suffer from MCF almost as much as men do. Nonetheless, the male/female ratio markedly 
increased in the patients aged 21-30. This may be attributed to the change in the roles played 
by men and women in the 21-30 age group. In this age group, men are more active in the 
workplace, while women are more preoccupied with childbirth and childcare (24).  
Previous studies have demonstrated different etiologies of MCF in various countries. Violence 
has been identified as the most common aetiology in Scotland (3) and Finland (6). In addition, 
falls are the most common cause in Sri Lanka (2). However, recent studies have indicated that 
RTA has been the most common cause of condylar fractures in developed and developing 
countries (4, 5, 9, 10, 24). RTA was also the leading cause of trauma in the current 
investigation. The disparity in outcomes observed in the current study and those of other studies 
can be attributed to population mobility, careless driving, unsafe roads, improper road traffic 
policies, unsafe cars, discrepancies in geographical areas, people's socioeconomic status, and 
date of injury. 

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Loukota et al (23) a straightforward and accurate method for classifying condylar fractures was 
proposed. In this classification, condylar fractures have been divided into three categories, 
namely condylar head, condylar neck, and subcondylar fractures. In the current research, the 
most frequent fractures were subcondylar (49%), followed by condylar neck (45%) and 
condylar head (6%) fractures. Similar results were also obtained by Zachariades et al (10), 
Sawazaki et al (5), and Reddy et al (25). However, condylar head fractures are most common 
in a few studies (24, 26). Moreover, several studies demonstrated that the location of condylar 
fractures was directly affected by the cause of the injury (9, 10). According to Marker et al (4), 
condylar head fractures occurred more frequently in cases where considerable force was 
involved. In other words, sub-condylar fractures were more likely to occur when the damage 
was caused by a weak force (alleged assault). The present study results revealed no significant 
relationship between the aetiology and location of the fractures. However, there were no 
patients under 12 in this study. Children are more prone to condylar head fractures (27). 
MacLennan (14) classified the types of fractures into four groups. In the current study, 
MacLennan's class III was the predominant type of MCF (36.6%), consistent with other studies' 
results (9, 10). On the contrary, Zhou et al (24) disclosed that class IV was the most common 
type of MCF. Research indicates that severe fractures (MacLennan's class IV) are more 
prevalent in instances resulting from high-velocity accidents, such as falls and road traffic 
accidents (RTA). In contrast, MacLennan's class I and II condylar fractures typically resulted 
from assaults characterised by lower force intensities (24, 26). The current investigation did 
not find any evidence of a substantial connection between the aetiology and the kind of 
fractures it examined. 
The study findings demonstrated that bilateral fractures occurred slightly more frequently when 
a considerable force was applied (RTA). In contrast, unilateral fractures occurred when a weak 
force was applied (alleged assault). Similar results were obtained by Marker et al (4).  
In the present study, individuals with concomitant mandibular fractures with condylar fractures 
comprised 68% of the sample. The most commonly associated mandibular fracture with 

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condylar fracture was symphysis fractures, followed by mandibular body fractures. These 
findings were consistent with those of the previous studies conducted on the issue (5, 6, 10, 
12). In the present study, symphysis fractures were found more frequently in the cases with 
bilateral condylar fractures, which was in line with the findings of the study by Zhou et al. (24). 
Nevertheless, body fractures occurred more often in instances with unilateral condylar fractures 
compared to those with bilateral condylar fractures. The fracture angle was marginally elevated 
in instances of unilateral condylar fractures. Zhou et al (24) did not find any significant 
relationships between mandibular body fractures and the severity of condylar fractures 
(unilateral or bilateral condyle fractures). 
Nonetheless, they observed a significant relationship between mandibular angle fractures and 
the fracture severity (unilateral or bilateral condyle fracture). Generally, the mandibular body 
and angle fractures absorb a part of the applied force, causing unilateral fractures. However, 
the force exerted on the mandibular body and angle can be transmitted along the mandibular 
arch, leading to contralateral condyle fracture. In the research by Zhou et al (24), no significant 
relationship was observed between maxillary fracture and fracture severity (unilateral or 
bilateral condyle fracture). However, this relationship was significant in the current study. 
Accordingly, maxillary fracture was more frequent in the patients with bilateral condylar 
fractures. In individuals with bilateral condylar fractures, significant strain is exerted on the 
head and face, leading to maxillary fracture. 
 
 
 

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Conclusion: 
The findings of the current investigation indicated that road traffic accidents were the 
predominant cause of mandibular condylar fractures. The findings indicated no substantial 
correlation between the different sources of condylar fractures and gender, age, as well as the 
location and type of fractures. The subcondylar region was the predominant site for condylar 
fractures, with MacLennan class III being the most prevalent form. Furthermore, symphysis 
and maxillary fractures were more prevalent in individuals with bilateral condylar fractures 
compared to those with unilateral condylar fractures. In contrast, mandibular body fractures 
occurred more often in instances with unilateral fractures compared to those with bilateral 
condylar fractures. 
 
Acknowledgement: The authors would like to thank Ms. A. Keivanshekouh at the Research 
Consultation Center (RCC) of Shiraz University of Medical Sciences for improving the use of 
English in the manuscript.  
Disclaimer:  
Conflict of interest:  
Funding disclosure:  
 
 
 

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Sriraam KG, Vignesh KRA. Diagnosis and management of mandibular condyle 
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Table 1: Gender distribution across various age demographics 
Age (years) 
Male 
Female 
Total 
P-value 
Male:female ratio 
12-20 
19 (20.2%) 
4 (14.3%) 
23 (18.9%) 
0.482 
4.75:1 
21-30 
35 (37.2%) 
13 (46.4%) 
48 (39.3%) 
0.382 
2.69:1 
31-40 
22 (23.4%) 
5 (17.9%) 
27 (22.1%) 
0.535 
4.40:1 
41-50 
12 (12.8%) 
4 (14.3%) 
16 (13.1%) 
0.834 
3.00:1 
>50 
6 (6.4%) 
2 (7.1%) 
8 (6.6%) 
0.887 
3.00:1 
 
 
Table 2: Sex and age distribution according to different etiologies 
Etiology 
Sex distribution (n=122) 
Age 
Male 
Female 
P-value 
Male (mean ± 
SD) 
Female (mean 
± SD) 
P-value 
Road traffic 
accident 
70 (74.5%) 
22 (78.6%) 
0.658 
31.46±11.56 
30.77±11.59 
0.809 
Falling down 
16 (17.0%) 
6 (21.4%) 
0.594 
28.69±11.38 
28.68±15.83 
0.997 
Assault 
8 (8.5%) 
0 (0.0%) 
0.110 
29.50±6.74 
- 
- 
 
 
 
 
 
 
 
 

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Table 3: Type and location of the fractures according to different etiologies 
Etiology 
MacLennan class of fractures (n=153) 
Location of fractures (n=153) 
I 
II 
III 
IV 
P-
value 
Condylar 
head 
Condylar 
neck 
Subcondylar 
P-
value 
RTA 
12 
(7.8%) 
31 
(20.3%) 
41 
(26.8%) 
36 
(23.5%) 
0.706 
8 
(5.2%) 
51 
(33.3%) 
61 
(39.9%) 
0.292 
Falling down 
1 
(0.7%) 
7 
(4.6%) 
10 
(6.5%) 
7 
(4.6%) 
1 
(0.7%) 
12 
(7.8%) 
12 
(7.8%) 
Assault 
0 
(0%) 
0 
(0%) 
5 
(3.3%) 
3 
(1.9%) 
0 
(0%) 
6 
(4.0%) 
2 
(1.3%) 
 
 
Table 4: Fracture severity based on the injury's aetiology 
Etiology 
Severity of injury (n=122) 
UF (n=91) 
BF (n=31) 
P-value 
RTA 
64  (70.3%) 
28  (90.3%) 
0.071 
Falling down 
19 (20.9%) 
3  (9.7%) 
Assault 
8  (8.8%) 
0  (0%) 
UF, unilateral fracture; BF, bilateral fracture; RTA, road traffic accident. 
 
 
 
 
 
 
 
 

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Table 5: The incidence of individuals with concomitant injuries related to unilateral and 
bilateral condylar fractures 
Associated injuries 
Number of patients with 
UF (n=91) 
Number of patients with 
BF 
(n=31) 
Total 
(n=122) 
P-value 
Mandibular fractures 
 
Symphysis 
39 (42.8%) 
21 (67.7%) 
60 (49.1%) 
0.017 
Body 
25 (27.4%) 
2 (6.4%) 
27 (22.1%) 
0.015 
Angle 
11 (12.0%) 
0 (0%) 
11 (9.0%) 
0.064 
Ramus 
5 (5.4%) 
2 (6.4%) 
7 (5.7%) 
1.000 
Coronoid 
3 (3.2%) 
1 (3.2%) 
4 (3.2%) 
1.000 
Maxillary fractures 
18 (19.7%) 
12 (38.7%) 
30 (24.5%) 
0.035 
Zygomatic fractures 
16 (17.5%) 
6 (19.3%) 
22 (18.0%) 
0.825 
Nasal fractures 
14 (15.3%) 
7 (22.5%) 
21 (17.2%) 
0.359 
UF, unilateral fracture; BF, bilateral fracture.       
 
 
 
 
 
 
 
 

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Table 6: The average angle of the fracture line with the posterior border of the ramus in 
instances of condylar neck and sub-condylar fractures based on the injury's source. 
Etiology 
Angle (Mean ± SD) 
P-value 
Road traffic accident 
120.83±11.79 
0.711 
Falling down 
121.98±8.26 
Assault 
118.13±11.20 
 
 

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Figure 1: A: Condylar head fracture: articular surface fracture line may extend outside 
capsule. B: Condylar neck fracture: the fracture line begins above line x and goes above 
it in over half. Line x runs perpendicularly from the sigmoid notch to the ramus tangent. 
C: Sub-condylar fracture: below the mandibular foramen and below line x in over half. 
 
 

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Figure 2: A: Non-displaced, B: deviated, C: displaced, D: dislocated. 
 
 
 

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Figure 3: The fracture line angle