Inclination Angle in Greenstick Fracture of Mandibular Subcondyle Treated with Intermaxillary Fixation in an Elderly Patient

This study presents the outcomes of a conservative approach to greenstick condylar fracture treatment in an elderly patient. Serial changes of the inclination angle were measured in a greenstick fracture of the mandibular subcondyle treated with intermaxillary fixation (IMF). A 64-year-old woman presented to an outpatient clinic complaining of pain on her chin. While waiting for an elevator, she lost consciousness and hit her face on the floor. She had a limited mouth-opening of 13 mm. Panoramic radiography and computed tomography confirmed a greenstick (incomplete) fracture of the left condyle, in which the lateral side of the bone was fractured and the medial side was bent. The medial inclination was approximately 40.4 degrees. On the second post-trauma day, IMF was performed using arch-bars and a prefabricated occlusal stop. Serial Towne’s views were taken. The inclination of the fractured condyle was measured and compared with the contralateral side. The difference in inclination angles (DI) between the fractured and contralateral sides was plotted over time. In SPSS version 19.0, an exponential regression model was constructed. In this patient, a greenstick (incomplete) fracture of the condyle (40.4 degree inclination) was treated with IMF and a pre-fabricated occlusal stop. On day 42 post-IMF, the inclination angle had decreased to 15.6 degrees, only 5.4 degrees greater than the contralateral side. The DI was fitted to exponential regression model (y = 25.111e(−0.028x), P = 0.004). This case shows that even in an elderly patient, a greenstick fracture of the mandibular condyle can be treated by vertical lengthening using an occlusal stop and IMF.