Fractures of the mandibular condyle account for approximately 25–35% of all mandibular fractures and represent one of the most frequently encountered injuries in maxillofacial trauma [1]. Road traffic accidents remain the most common cause, followed by interpersonal violence, falls, and sports related injuries. Management of condylar fractures has long been controversial. Traditionally, closed reduction with inter-maxillary fixation was widely practiced; however, this approach may be associated with prolonged immobilization, malocclusion, restricted mandibular movement, and temporomandibular joint dysfunction [2]. Over the past several decades, open reduction and internal fixation (ORIF) have gained wider acceptance because it enables accurate anatomical reduction, early mobilization, and improved functional outcomes [3]. Established indications for surgical management include significant displacement, loss of ramus height, inability to achieve occlusion through closed techniques, and bilateral fractures in edentulous patients [4]. According to the principles of osteosynthesis proposed by Champy and colleagues, placement of fixation plates along the ideal lines of osteosynthesis provides biomechanically stable fixation by counteracting tensile and compressive forces generated during mastication [5]. In condylar fractures, stabilization with two miniplates positioned along these lines has therefore become a commonly used fixation method. Despite its effectiveness, the double-miniplate technique requires wider surgical exposure and insertion of multiple screws, which may increase operative complexity. In the anatomically constrained condylar region, surgical access may be limited and proximity to the facial nerve further complicates plate placement. To address these limitations, specialized plate designs have been developed. One such design is the delta plate, characterized by its triangular configuration. This geometry allows distribution of functional forces across three fixation points, thereby providing three-dimensional stability with a single plate system. Biomechanical studies have demonstrated that triangular plate configurations effectively resist torsion and bending forces generated during mandibular function [6–8]. However, clinical evidence comparing delta plates with conventional double-miniplate fixation remains limited. Therefore, the present multicenter prospective study was undertaken to compare the clinical outcomes, radiographic stability, and surgical handling characteristics of delta plate fixation with those of double-miniplate osteosynthesis in the management of mandibular condylar fractures

STUDY DESIGN A prospective multicenter clinical study was conducted in the Departments of Oral and Maxillofacial Surgery at two tertiary care centers after obtaining approval from the Institutional Ethics Committees of both institutions. SAMPLE The sample size was determined based on feasibility and patient availability during the study period. A total of 36 patients diagnosed with unilateral mandibular condylar or subcondylar fractures requiring surgical management were included. Patients were allocated into two groups: Group I underwent fixation with two 4-hole titanium miniplates (n = 18), while Group II underwent fixation using a titanium delta plate (n = 18). Patients were allocated into two groups using a non-randomized consecutive sampling method. INCLUSION CRITERIA Inclusion criteria included patients aged 18 years or older presenting with unilateral condylar or subcondylar fractures requiring open reduction and internal fixation. Only patients who provided written informed consent and were available for regular postoperative follow-up were included in the study. EXCLUSION CRITERIA Exclusion criteria included pathological fractures, comminuted condylar fractures unsuitable for plate fixation, medically compromised patients, and patients unwilling or unable to comply with the follow-up protocol. SURGICAL PROCEDURE Preoperative assessment was performed using orthopantomograms (OPG) and reverse Towne radiographs to evaluate fracture configuration, plan reduction, and assess restoration of ramus height (Fig. 1). PREOPERATIVE ORTHOPANTOMOGRAM (OPG) DEMONSTRATING A DISPLACED UNILATERAL MANDIBULAR CONDYLAR FRACTURE WITH LOSS OF RAMUS HEIGHT All procedures were carried out under general anesthesia. Surgical exposure of the fracture site was achieved using standard approaches, predominantly the retromandibular approach, depending on the fracture location (Fig. 2). Intraoperative view of the fracture site and its exposure via retromandibular approach and anatomical reduction of the condylar segment. In Group I, fixation was performed using two 4-hole titanium miniplates secured with 2.0-mm screws in accordance with Champy’s principles (Fig. 3). Intraoperative photograph showing fixation using two 4-hole titanium miniplates placed along the ideal lines of osteosynthesis. In Group II, fixation was achieved using a titanium delta plate secured with four 2.0-mm screws (Fig. 4). Intraoperative photograph demonstrating fixation using a titanium delta plate with triangular configuration providing three-dimensional stability. Intermaxillary fixation was applied intraoperatively to establish proper occlusion prior to definitive plate fixation. CLINICAL EVALUATION It included assessment of maximal interincisal mouth opening, occlusal stability, and mandibular deviation during mouth opening, and postoperative pain using the Visual Analog Scale (VAS). The presence of postoperative complications, including infection and hardware-related problems, was also recorded. RADIOGRAPHIC EVALUATION Radiographic Evaluation was performed using

Thirty-six patients completed the study with follow-up to six months. Functional outcomes are detailed in Table1 Table 1: Comparison of Clinical Outcomes between Delta Plate and Double Miniplate Fixation Parameter Delta Plate (n = 18) Double Miniplate (n = 18) p-value Mean age (years) 31.4 ± 8.2 32.1 ± 7.6 >0.05 Preoperative MIO (mm) 21 ± 3.4 25 ± 4.1 >0.05 MIO at 3 months (mm) 31 ± 3.2 28 ± 3.5 >0.05 MIO at 6 months (mm) 40.6 ± 3.1 39.2 ± 2.8 >0.05 Operative time (minutes) 21.5 ± 3.6 34.4 ± 4.2 <0.001 Mandibular deviation at 6 months 0 2 >0.05 Postoperative infection 0 3 >0.05 Facial nerve neuropraxia 2 2 >0.05 The mean maximal mouth opening at six months was 39.2 mm in Group I (double-miniplate fixation) and 40.6 mm in Group II (delta plate fixation). The difference between groups was not statistically significant (p > 0.05). Mild mandibular deviation during mouth opening was observed in a few patients in the early postoperative period but resolved during follow-up with physiotherapy. Occlusal stability was achieved in all patients by the final follow-up visit. PAIN ASSESSMENT VAS scores decreased progressively in both groups. By six months, minimal pain was reported and no statistically significant difference was observed between the groups. RADIOGRAPHIC FINDINGS Postoperative radiographs demonstrated satisfactory fracture reduction and restoration of ramus height in both groups. No cases of plate fracture, screw loosening, or secondary displacement were observed. (Fig. 5A, B, C, D) OPERATIVE HANDLING Delta plate fixation required less intra-operative time compared with the double-miniplate technique, which shows high statistically significance value (p <<0.001). No permanent facial nerve injury was observed. Two patients demonstrated transient weakness of the buccal branch of the facial nerve, which resolved within one month postoperatively. No implant failure or major postoperative complications were observed.

Management of mandibular condylar fractures continues to be a subject of considerable debate in maxillofacial trauma surgery. While closed reduction has historically been advocated to avoid surgical risks, it is often associated with complications such as malocclusion, restricted mandibular movement, and temporomandibular joint dysfunction. Consequently, open reduction and internal fixation (ORIF) have increasingly become the preferred modality in displaced fractures, allowing anatomical reduction and early functional rehabilitation [1-4]. Long-term biological and functional considerations have further supported surgical intervention in appropriately selected cases [15, 16]. According to Champy’s principles, fixation along ideal lines of osteosynthesis provides stability by counteracting functional forces [5]. In condylar fractures, the double-miniplate technique has been widely accepted due to its ability to resist bending and torsional stresses [6]. However, its application in the condylar region can be technically demanding due to limited surgical access and proximity to the facial nerve [7]. Previous clinical studies have also highlighted the challenges associated with plate adaptation and screw placement in this anatomically constrained region [17, 18]. To overcome these limitations, geometrically optimized plate designs such as the delta plate have been introduced. The triangular configuration enables three-dimensional stability by distributing forces across multiple vectors. Biomechanical and finite element studies have demonstrated improved stress distribution and resistance to functional loading with triangular plate systems compared to conventional linear miniplates [8–11, 19, 21]. These findings support the concept that multidirectional load sharing enhances fixation stability in condylar fractures. In the present multicentre prospective study, both fixation methods demonstrated comparable functional outcomes. Maximal mouth opening, occlusal stability, and pain reduction showed no statistically significant differences between the groups at six months. These findings are consistent with previous clinical studies reporting favourable outcomes with delta plate fixation [12–14]. Furthermore, systematic reviews and contemporary analyses have confirmed that ORIF provides superior functional outcomes compared to closed treatment in selected cases [23]. Radiographic evaluation confirmed satisfactory fracture reduction and maintenance of ramus height in both groups, with no cases of hardware failure or secondary displacement. These findings indicate that both systems provide adequate mechanical stability for fracture healing. Earlier studies evaluating rigid fixation techniques have similarly demonstrated predictable radiographic outcomes when appropriate osteosynthesis principles are followed [20, 22]. An important observation in this study was the reduced operative handling associated with delta plate fixation. The use of a single plate with fewer screws simplifies the procedure, particularly in anatomically constrained regions. This may reduce operative time and surgical manipulation, potentially lowering the risk of iatrogenic injury, including facial nerve involvement. In the present study, no permanent facial nerve injury was observed. Two patients exhibited transient weakness of the buccal branch, which resolved within one month, indicating minimal neurological morbidity. These findings are consistent with previously reported low complication rates associated with carefully performed ORIF procedures [18, 24]. While delta plates offer advantages in surgical handling and reduced hardware requirements, the double-miniplate technique remains a well-established and reliable method, particularly in complex fracture patterns. Therefore, the choice of fixation should be individualized based on fracture characteristics and surgeon experience. The present study contributes to the growing body of evidence supporting geometrically optimized fixation systems in maxillofacial trauma, highlighting the clinical applicability of delta plate osteosynthesis in routine surgical practice. CLINICAL RELEVANCE Delta plates offer a simplified fixation strategy for mandibular condylar fractures by providing three‑dimensional stability with fewer screws and reduced operative manipulation. Their use may simplify surgical handling in anatomically restricted regions while maintaining functional outcomes comparable to conventional double-miniplate osteosynthesis. LIMITATIONS The present study has several limitations. The sample size was relatively small, which may limit the statistical power of the findings. However, surgically treated condylar fractures represent only a selective subset of mandibular fractures, thereby restricting patient recruitment during the study period. Additionally, the follow-up duration was limited to six months, and therefore long term outcomes such as temporomandibular joint remodeling and implant fatigue could not be evaluated.

Both delta plate fixation and double-miniplate osteosynthesis provide reliable stabilization for mandibular condylar fractures with satisfactory functional and radiographic outcomes. The results of this multicenter prospective study suggest that delta plates provide comparable clinical performance while offering advantages including reduced hardware requirements, simplified plate adaptation, and decreased operative handling time. Further studies involving larger patient populations and longer follow-up periods are required to confirm the long term clinical efficacy of this fixation technique.

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