Purpose: To share our experience in the open reduction and single screw internal fixation of delayed bilateral condylar head fractures with fragmentation and evaluate its feasibility and outcomes. Patients and methods: The study involved 6 males and 1 female. All patients had multiple injuries at different body sites and failed non-surgical treatment of bilateral condylar head fractures. The mean period between the injury and the operation was 5.7 (4-8) weeks. According to the preoperative computer-aided design, and the clinical manifestations, the fracture fragments were reduced and fixed with a single screw. A helical CT scan was requested postoperatively to check the reduction of the fragments and the location of the screws. Mean follow-up duration was 9.7 (8-14) months. Result: The malocclusion was corrected after operation. The intraoperative passive mouth opening was 3.93 +/- 0.19 cm. The mouth opening was 3.43 +/- 0.35 cm in 3 months follow-up, and more than 3 transverse fingers at the last follow up. No one had a progressive limitation of the mouth opening in 8-14 months of follow up. Conclusions: The strategy of open reduction and single screw internal fixation of bilateral condylar head fracture with fragmentation of mandible is feasible and effective. It is a treatment option in the rare delayed cases of failed non-surgical treatment. (C) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.