Study Limitations NOS score Risk of bias
McGoldrick et al. [8] - Retrospective data with possibility of missed data. Factors such as range of motion, deviation and opening measurements were not uniformly recorded in patient notes.
- Small sample limits the applicability of statistical analysis and comparisons between groups.
- Unable to assess potential long-term complications with length of follow-up. 		5/9 High
Strobl et al. [9] - Prospective case series.
- In a randomized clinical trial, patients should be assigned to various treatment groups, including active physiotherapy with and without preceding IMF and myofunctional activator therapy with and without preceding IMF.
- Strengths: Long term follow-up through the complete growth period. Sample size of 55 relatively large for this type of fracture. 		6/9 High
Aksoyler et al. [10] - Prospective but not comparative, i.e. case series.
- Small sample (6 cases).
- Relatively short follow-up (18 months).
- Specific sub-cohort of condylar fractures. 		5/9 High
Kim and Nam [11] - Case series.
- Small sample (11 cases). 		5/9 High
Choi et al. [12] - Case series.
- Small sample (11 cases).
- Wide range of follow-up from short (1 year) to adequate.
- Strength – more accurate assessment of condylar remodelling with CT as opposed to OPG alone (however higher radiation dose to paediatric patients). 		5/9 High
Yadav et al. [13] - Short follow-up (1 year).
- Case series. 		5/9 High
Li et al. [14] - Did not separate bilateral fractures and unilateral fractures.
- Better grouping should lead to a more convincing conclusion.
- However, based on the data volume, sub-grouping the cases into bilateral fractures and unilateral fractures would further decrease the data size and lead to insufficient case numbers for each group. 		8/9 Low
Vesnaver et al. [15] - Case series.
- Small sample.
- Good length of follow-up. 		5/9 High
Cooney et al. [16] - Short follow-up.
- Retrospective and case series.
- Loss to follow-up.
- Compared to other studies.
- Modest/good sample size. 		5/9 High
Liu et al. [17] - Case series.
- Retrospective.
- Small to modest sample size. 		5/9 High
Wu et al. [18] - Case series.
- Retrospective.
- Specific sub-cohort of condylar fractures.
- Small sample size. 		5/9 High
Theologie-Lygidakis et al. [19] - Late follow-up excludes those condyle fractures requiring surgery so only records for non-surgical management.
- Therefore not truly comparative and more of a large case series.
- Retrospective.
- Good sample size. 		7/9 High
Zhang et al. [20] - Retrospective.
- Small sample size. 		6/9 High
Hovinga et al. [21] - Retrospective.
- Case series.
- Small to modest sample size.
- Very long follow-up compared to most studies so truly able to assess long term implications on growth. 		6/9 High
Zhao et al. [22] - Insufficient length to identify long term effects on growth.
- Modest sample size.
- Wide age range so accounts for different 'remodelling/growth potential' due to of condyle/patient.
- Retrospective.
- Case series. 		5/9 High
Zhang et al. [23] - Small sample size.
- Case series.
- Good long term follow-up. 		5/9 High
Güven and Keskin [24] - Retrospective.
- Case series.
- Small sample. 		5/9 High
Schiel et al. [25] - Retrospective.
- Case series.
- Small sample. 		5/9 High
Thorén et al. [26] - Retrospective.
- Case series.
- Small sample. 		6/9 High
Landes et al. [27] - Patient number is limited.
- Full randomization of closed vs open treatment was originally planned, however, not judged ethically acceptable after the literature had been reviewed. 		8/9 Low

NOS = The Newcastle Ottawa Scale; IMF = intermaxillary fixation; CT = computed tomography; OPG = orthopantograms.