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.