Mandibular Condylar Fractures: A Comparison of Surgical Versus Conservative Treatment Outcomes and Prognostic Factors—A Single‐Center Retrospective Study (2011–2024)

BACKGROUND: The optimal management of mandibular condylar fractures-surgical versus conservative-remains debated. While surgery aims for anatomical restoration, conservative treatment relies on natural remodelling, especially in children. High-level evidence guiding individualised decisions based on age, fracture type and displacement is still lacking. OBJECTIVE: To compare surgical and conservative treatment outcomes and identify treatment-specific prognostic factors. METHODS: This single-centre retrospective cohort included 235 patients with 297 fracture sides treated between 2011 and 2024. The primary comparison included 155 surgically and 69 conservatively treated patients; 11 receiving mixed bilateral treatment were excluded. Propensity-score overlap weighting was used to adjust for baseline differences. Prognostic factors were evaluated using multivariable logistic regression, with Firth regression applied when separation occurred. A sensitivity analysis included patients followed for ≥ 24 months. RESULTS: Treatment success was 83.2% after surgery and 87.0% after conservative treatment (p = 0.554). Adults underwent surgery more frequently than children (77.4% vs. 50.7%; p < 0.001). After overlap weighting, failure risks were 18.5% and 16.4%, respectively (risk difference = 2.18 percentage points; 95% CI, -10.57 to 14.89). No independent factor was identified in the surgical group. In the conservative group, displaced fractures had greater odds of failure than fractures with no or minimal displacement (adjusted OR = 7.61; 95% CI, 1.45-77.84; p = 0.014). Individual functional outcomes did not differ between groups. Results were consistent among patients followed for ≥ 24 months (p = 1.000). CONCLUSION: No significant difference in treatment failure was detected after adjustment, although equivalence cannot be inferred. Fracture displacement was associated with conservative treatment failure and may inform individualised treatment and follow-up.