Comparative Evaluation of Conventional (Static) Versus Dynamic Elastic Therapy for Closed Treatment of Unilateral Mandibular Sub-Condylar Fractures: A Randomized Controlled Trial.

Background: The treatment of mandibular sub-condyle fractures is controversial. Guiding elastics play an important role in managing sub-condylar fractures, as their rationale revolves around the vector and traction alteration of the fractured ends. Purpose: This study aims to compare the outcomes of conventional closed treatment and dynamic elastic therapy for the treatment of unilateral mandibular sub-condylar fractures. Study design: The study design was a double-blinded prospective randomized controlled trial. Patients ≥ 18 years of age, with unilateral sub-condylar fractures with or without associated mandibular fractures, were randomized into experimental and control groups. Predictor: The predictor variable was the type of method used for fracture management, either conventional way or dynamic elastic therapy. Main Outcome Variables: Primary outcome variables were post-treatment occlusion, mouth opening, deviation, and patient satisfaction level scores and secondary outcome variables were protrusion, laterotrusive and mediotrusive movements, Ramal height, degree of displacement, and complications. Covariates: Age, etiology, and site of the associated mandibular fracture were the covariates. Analyses: Data were analyzed using the Student's t test, ANOVA followed by post hoc test, and frequencies were compared using the chi-square test. For all the statistical tests, p < 0.05 was considered to be statistically significant. Results: The study incorporated 34 patients, out of which 22 had sub-condylar fractures along with associated mandibular fractures, and the rest 12 were isolated. There were no significant differences between the two groups in terms of occlusion, mouth opening, Ramal height, mediotrusion, and laterotrusion, and degree of the displaced condyle. (p > 0.05). Among the GOHAI scale questions, used for patient satisfaction score assessment, question 10 produced a highly statistically significant p value < 0.001 (p value- 0.006). There is a statistically non-significant difference seen (p > 0.05) for the values of all variables between the groups, except for the protrusion baseline with higher values in the conventional group (p = 0.044) and deviation baseline with higher values in the dynamic elastic therapy group. (p = 0.018). Conclusions: Both treatment options provide satisfactory results for the management of sub-condylar fractures but novel guiding elastic therapy has few advantages over conventional elastic therapy such as improved treatment satisfaction.