Purpose <p>Surgical treatment of adult mandibular condylar head fractures (CHFs) is increasingly prevalent. This systematic review aims to synthesize data on long-term clinical and radiological outcomes and complications associated with various osteosynthesis materials used for CHFs.</p> Methods <p>A comprehensive literature search adhering to PRISMA guidelines was conducted across four databases between 1980 and 2024. All published studies evaluating clinical and radiographic outcomes and complications in adults undergoing open reduction and internal fixation with/without disc intervention for condylar head fractures were included. Clinical outcomes such as malocclusion, mouth opening, lateral excursion, protrusion, and TMJ pain, along with radiographic outcomes including condylar remodelling and ramal height restoration, were recorded. Joanna Briggs Institute checklist for critical appraisal and ROBVIS tool generic data set were used to assess the risk of bias. Descriptive statistics were applied to obtain the results.</p> Results <p>Twenty-nine studies were included.&#xa0;The review encompassed 848 patients (males = 364; females = 167; and gender not mentioned = 317) and 1087 sites, including 239 bilateral cases. Various osteosynthesis materials included titanium screws (<i>N</i> = 10), microplates with screws (<i>N</i> = 3), miniplates with screws (<i>N</i> = 3), resorbable screws (<i>N</i> = 2), and miscellaneous (<i>N</i> = 11). Disc repositioning was addressed in&#xa0;19 studies. The risk of bias in most studies was low.</p> Conclusion <p>Titanium screws were the most frequently used osteosynthesis material and demonstrated superior outcomes. Disc repositioning should be considered during open condylar fracture management. Future randomized controlled trials are imperative to determine the optimal choice among different osteosynthesis materials and soft tissue procedures.</p>