Fractal Analysis of Trabecular Pattern in Normal and Fractured Mandibular Condyles on Computed Tomography Images: A Retrospective Study

Background: The mandibular condyle has a complex trabecular structure that may change after trauma. Fractal analysis (FA) quantitatively evaluates trabecular complexity, while computed tomography (CT) provides detailed three-dimensional assessment of bony structures. Objective: To compare the fractal dimension (FD) values of trabecular bone in normal and fractured mandibular condyles using CT images. Methods: This retrospective study analyzed 90 CT volumes (45 each group). Fractal dimension was compared between groups using Welch’s independent-samples t -test; inter-observer reliability was assessed with the intraclass correlation coefficient, inter-observer correlation with Pearson’s coefficient, and diagnostic performance with receiver operating characteristic (ROC) analysis. Results: Fractured condyles showed significantly lower FD than normal condyles (0.685 ± 0.087 vs 0.767 ± 0.039; P < 0.001). A significant association with gender was observed ( P = 0.003), with male predominance in the fracture group, whereas no significant association with age was found ( P = 0.120). Inter-observer reliability showed moderate agreement for single measurements (ICC = 0.590) and good agreement for average measurements (ICC = 0.812). FD discriminated fractured from normal condyles with acceptable-to-good accuracy (AUC 0.70–0.82 across observers; 0.81 for the averaged measurement). Conclusion: Fractal analysis of CT images may serve as a valuable and reliable quantitative tool for assessment and follow-up of trabecular alterations in mandibular condylar fractures, rather than serving as a standalone diagnostic method.