Fractures involving the mandibular condyle are counted among the most frequent injuries to the facial skeleton, and their operative care remains a highly debated issue within maxillofacial trauma practice. A broad body of international research has explored optimal therapeutic pathways, with a rising inclination toward open reduction and internal fixation (ORIF). Whereas non-surgical care has conventionally served as the benchmark for intra-articular fractures, contemporary evidence suggests that ORIF may be suitable for selected presentations of these injuries. The null proposition underpinning this study posits that there is no notable disparity in functional and clinical endpoints between operative intervention via open reduction and internal fixation (ORIF) and non-operative, conservative measures for intra-articular fractures of the mandibular condyle. This work presents a 14-year retrospective survey (2009–2023) of the authors’ institutional experience with operative management of intra-articular condylar fractures. Data were gathered covering operative techniques, early and late adverse events, clinical and radiographic endpoints, and contrasts with non-surgical treatment. The review comprised appraisals of both short- and long-term consequences following ORIF, singling out particular settings wherein ORIF exhibited superiority over non-surgical measures. Clinical and imaging assessments provided useful insights into patient convalescence and functional recovery, whilst complication frequencies were cataloged for both modalities. Findings imply that ORIF may constitute an advantageous therapeutic option for intra-articular condylar fractures within defined patient subsets, providing superior outcomes when non-surgical therapy could fall short. That said, non-surgical measures remain a legitimate recourse whenever operative risks outweigh anticipated benefits. This inquiry feeds into the broader dialogue, endorsing a bespoke strategy that accounts for individual patient variables when weighing ORIF against non-surgical therapy.
