National Trends, Postoperative Antibiotic Utilization, and Complications Following Operative Management of Mandibular Condylar Fractures: A TriNetX Database Review.

BACKGROUND: Debate persists regarding the management of condylar fractures. While systematic reviews and retrospective studies have examined clinical outcomes, national complication profiles, and postoperative antibiotic utilization remain incompletely characterized. METHODS: The authors performed a retrospective cohort study utilizing the TriNetX database. The authors identified patients with condylar fractures treated with open reduction and internal fixation (ORIF) or closed treatment from 2010 to 2025. Patients were identified by ICD-10 fracture codes and categorized into closed or open treatment cohorts through CPT codes. Outcomes included postoperative complications, reoperation, postoperative antibiotic utilization, and temporal trends in treatment approach. Concomitant craniofacial injuries were evaluated to compare injury burden among cohorts. RESULTS: In this review of 8185 patients with condylar fractures, 33.5% underwent ORIF, and 66.5% were managed with closed treatment. Craniofacial injury burden was similar between cohorts. ORIF was associated with a higher overall complication rate (12.6% versus 9.2%), higher postoperative infection rate (6.8% versus 2.3%), and higher antibiotic utilization (36.1% versus 32.0%). Conversely, reoperation rates were higher after closed treatment (8.0% versus 4.0%). The proportion of fractures managed with ORIF was significantly higher after 2015 (OR: 1.21, P<0.001). CONCLUSIONS: In our large, multi-institutional database cohort study, ORIF of condylar fractures increased after 2015 and was associated with higher postoperative complication rates. Postoperative antibiotic usage was higher in ORIF, despite elevated infection rates. Our findings highlight evolving treatment patterns for condylar fractures, variations in perioperative management, and the importance of ongoing diligence in patient selection. LEVEL OF EVIDENCE: Level III.