Fractures of the condyles of the tibia. Classification, diagnosis and treatment

Fractures of the condyles tibia frequent sports injury, if the direction of the traumatic force passes through the axis of the bone, that is, from top to bottom, for example, when landing on straight legs during a long jump or falling from a sports motorcycle. But it can be the consequences of an accident, falling from a height or on ice. There are options for a fracture of the internal or external condyle, or both at once, as well as intra- and extra-articular fracture, depending on the passage of the fault line.

The structure of a healthy knee joint

The joint is formed by three bones: the femur, tibia and patella. Above the femur, two condyles form the articular surface: the outer or lateral and the inner or medial. Below is the articular surface of the tibia, and on the side is the patella. From the inside, the joints are covered with smooth cartilage tissue, for better glide and greater range of motion. Peculiarities histological structure condyles of the femur and tibia involves the receipt of depressed and impacted fractures, since its structure is plastic and easily bent.
Quite often, fractures of the condyles of the tibia pass with displacement of the fragments and a violation of the biomechanics of the joint. This entails a violation of the distribution of forces acting on the joint during walking and other physical activities. And after healing, if it happened incorrectly, inflammation of the articular bag may occur, since the deviated parts of the bone will constantly “scratch” the inner surface of the joint or, under the weight of the body, the articular surfaces will become incongruent to each other.

Fracture of the lateral condyle of the tibia

It occurs most often as a result of violent actions, or excessive abduction of the leg to the side below the knee joint (occurs with sports injuries or accidents). X-ray shows a displacement of the lateral condyle by more than four millimeters, the fault line runs obliquely or vertically. If the traumatic agent continues to act on the leg, then the fragments are displaced, otherwise (provided that the limb is immobilized during transportation), the fracture passes without displacement.

Fracture of the lateral condyle of the tibia

This type of fracture occurs if the lower leg is brought to the hip or the knee is bent more than forty-five degrees at the time of injury. It is equally common in everyday life, sports and accidents. It is also possible to localize the fracture by the pictures in frontal and lateral projection, a vertical picture of the articular area. If nothing strange is found during standard X-rays, and the symptoms persist, it makes sense to take an x-ray in an oblique projection.

Fracture symptoms

The patient will most often complain of pain in the knee at rest and at the slightest movement, an inflammatory reaction with accumulation of exudate is objectively visible, a violation of the integrity of the skin over the site of impact, a decrease in the volume of active and passive movements in the joint. The characteristic external deformation and defiguration of the joint is expressed. The patient is forced to take the position that is the least painful for him - the knee is slightly bent to reduce the tension of the ligaments, the muscles are relaxed. Most often, condylar fractures are not isolated, they are combined with rupture of the anterior or posterior cruciate ligaments, lateral ligaments, discs, menisci. Damage to blood vessels and nerves that feed the joint. The latter is manifested in a decrease in the temperature of the lower leg and foot, a violation of sensitivity.

Treatment

There are four most common ways to treat a knee fracture and their combinations:
1. Pressure bandage (holding fragments from displacement).
2. Plaster cast and closed comparison of fragments.
3. Skeletal traction.
4. Open reposition, connection of fragments with fixing material (pins, plates).
How the injury will heal depends on the nature of the fracture, its type, the presence of additional pathologies and complications, as well as on the method used by the traumatologist.

The first two methods are conservative treatment, involving cold therapy, immobilization and a gradual increase in the load on the leg in general and the joint in particular. During the entire treatment, images of the healing leg are taken to monitor the process and prevent displacement of fragments or shortening of the limb. Plus, the patient is prescribed exercise therapy to prevent contractures and reduce the range of motion in the joints. Such therapy is more suitable for older people who will not run, swim, or otherwise put a lot of stress on the leg in the future.
The last two methods are operational, when, one way or another, they are involved invasive methods treatment. It is important that the operation is performed by an experienced specialist, since it depends on him how accurately the fragments will fall into place and grow together again. You can fix them with screws, or add a metal plate to them. Often during the operation it is required to examine the inner surface of the joint, then arthroscopy or arthrotomy is used, depending on the clinical situation and the complexity of the fracture. The entire process of the operation is controlled radiologically, pictures are taken directly on the operating table, which are filed into the medical history for further comparison and tracking of the dynamics of bone restoration.

Such damage as a fracture of the condyle of the tibia is quite common. Anyone can receive it, of any gender, age. The condyles are spherical protrusions that are located at the bottom of the femur and perform a very important function - flexion and extension of the joint.

There are external condyle (lateral) and internal (medial). Their fracture in some cases is quite serious damage, which can have unpleasant consequences if measures are not taken in time to diagnose and properly treat the fracture.

Injury to the condyle - This is an intra-articular fracture of the lateral sections of the upper epiphysis of the femur. Often this injury occurs in conjunction with other injuries to the knee or may occur after damage to the tibia, which at first glance may seem minor.

The fracture may be displaced or not, complete or incomplete. Complete fractures occur when the entire condyle or part of it is separated. Incomplete are characterized by reproduction of cartilage, cracks, depressions. All condylar fractures can be divided into two large groups:

The congruence of the articular surface is not broken.
The congruence of the articular surface is broken.

The intercondylar eminence can also suffer from a fracture, but such injuries are extremely rare. Such a fracture is of a detachable nature, it is usually preceded by a sprain of the cruciate ligaments. Distinguish incomplete separation without displacement, incomplete separation with displacement, complete separation of the intercondylar eminence.

Causes of injury

A fracture of the condyle of the femur occurs when the strength of the bone is not strong enough to cope with the force acting on it. Most of these injuries occur as a result of a traffic accident, when the bumper of the car hits the proximal femur.

Also frequent are such injuries due to the impact of a direct mechanism, it can be a fall from a height. At the same time, excessive abduction of the lower leg outward can provoke an impression fracture of the lateral condyle of the tibia, excessive adduction - a fracture of the medial condyle.

Symptoms of condyle injury and their diagnosis

The first symptom of a condylar fracture is a sharp pain in the knee joint at the time of injury. The joint swells, increases in volume. A fracture of the external condyle is accompanied by a valgus deformity, that is, the lower leg moves outward, a fracture of the internal condyle causes varus deformity - the lower leg is shifted inward.

The ability to rely on the leg and its movements become sharply limited. There is atypical lateral movement of the joint. An outpouring of blood into the joint appears, with the help of palpation, the zone of maximum pain in the area of \u200b\u200bthe internal or external condyles is determined.

Diagnosing a condylar fracture is fairly easy with an x-ray of the knee. Pictures are taken in two projections, with their help, medical workers can determine the nature of the damage and the complexity.

If displacement has occurred, the doctor can assess the degree of displacement of the debris. If the radiography does not give unambiguous results, the victim is sent for a CT scan of the damaged joint. An MRI may be prescribed in situations where, in addition to the condyles, there is a suspicion of damage to the menisci or ligaments.

There are cases when a fracture of the condyles provokes pinching of blood vessels and nerves, in such a situation it is imperative to consult with the relevant specialists - a neurosurgeon, a vascular surgeon.

Treatment and rehabilitation

There are several main ways to treat the area of the knee joint: pressure bandage, closed juxtaposition of bone fragments (reposition) and plaster cast, open reduction with internal fixation and skeletal traction.

All these methods have as their goal: restoration of the joint, ensuring its early mobility, eliminating the load on the knee joint until complete healing. The choice of treatment is determined by the type of fracture, the age of the patient, and the experience of the orthopedic surgeon.

Types of fractures and how to treat them:

The terms of treatment and rehabilitation depend on how severe the injury was, how quickly the assistance was provided, and how the patient complies with the recommendations. medical workers to restore the functions of the knee joint.

During treatment, the patient is strictly contraindicated to walk even on crutches. It is necessary to give a load to the joint gradually, it is allowed to do this after the end of fixation of the leg, if it took place.

To develop the knee, physiotherapy exercises are used with a special set of exercises, which must be performed exclusively under the supervision of a medical worker.

In no case should you try to develop the joint yourself, this can lead to serious consequences, up to the loss of mobility. In addition to physiotherapy exercises, massage is also prescribed during rehabilitation, it helps to improve blood supply to tissues, restore muscle tone and elasticity.

At the same time, physiotherapy procedures are included in the recovery complex. Their task is to reduce tissue edema, reduce pain, restore vascular trophism and prevent post-traumatic arthrosis from developing.

Thus, in the treatment of fractures of the condyles of the femur a comprehensive recovery is important, which cannot be refused and ignored.

Possible Complications

So what are the possible consequences:

With long-term immobilization, a complete loss of motion of the knee joint may occur.
Perhaps the development of degenerative arthrosis, despite the correct and timely treatment.
It is possible to develop an angular deformity of the knee in the first few weeks, even in cases where the fracture was not initially displaced.
Such injuries can complicate the instability of the knee joint.
Open fractures can be complicated by infections when treated surgically.
Violation of the neurovascular bundle with tunnel syndrome, which complicates the treatment of such injuries.

Conclusion

With a fracture of the condyles of the tibia, as well as with any other, it is important, first of all, to diagnose the injury in time and determine its severity, and then strictly follow the advice of medical workers on treatment and rehabilitation, in this case the chance to avoid negative consequences increases significantly.

Limb fractures are among the most common. Especially their number increases in winter, when icing of sidewalks appears, which are reluctant to clean in our country. One of the most severe injuries of the articular surfaces, they bring a lot of trouble, take a very long time to heal and heal rather poorly. When diagnosing problems of this kind, a limb can shackle a person in plaster for a long time.

One of the most common leg injuries is a tibial condyle fracture. It can be both impression (intra-articular) and compression. Problems of this kind are especially common in people who have fallen from a height (for example, from a ladder, from a tree, or even from a window), while the legs must be in an unbent position. Today we’ll talk about how troubles of this kind are treated, how long they heal, and how rehabilitation after an injury goes.

What is this injury?

The condyle is a thickening at the end of a bone to which muscles and ligaments attach. There are two of them on the tibia:

Medial (internal).
Lateral (external).

The condyles are a rather fragile part of the bone, because, unlike the bone itself, they are covered with cartilage. It is more elastic and much less resistant to all kinds of damage.

As we said above, the cause of injuries of this kind are falls from a height and landing on even legs. If something like this is noted, the condyles are strongly compressed and the dense section of the metaphysis is pressed into the spongy substance of the epiphysis. Ultimately, the epiphysis is divided into two parts, due to which the outer and inner condyles simply break. A fracture may appear as two of these parts of the joint, or one of them. You can tell them apart by one simple feature:

if the lower leg moves to the outside - problems with the external condyle;

if the lower leg moves inward, the internal condyle is broken.

The classification of injuries of this kind is quite extensive. First of all, complete and incomplete damage is distinguished. In the first case, a complete or partial separation of the condyle is noted. If the fracture is incomplete, then cracks, indentation may be noted, but separation is not observed. In general, injuries are divided into two large groups:

Fractures without displacement.

Displaced fractures.

Condyle injuries are often diagnosed with a number of concomitant injuries. These include trauma to the fibula, ruptures or tears of the knee ligaments, menisci, fractures of the intercondylar eminence.

Characteristic manifestations and diagnosis

It is not difficult to identify fractures of this kind. First of all, the specialist will pay attention to the characteristic symptoms of an injury, which include:

soreness;

hemoarthritis;

dysfunction of the joint;

deformation characteristic of such injuries;

lateral movements in the knee joint.

It should be noted that pain in condyle fractures may not correspond to the complexity of the injury. Therefore, when diagnosing a problem, palpation is performed - feeling the area of \u200b\u200bdamage. Specialists do this in order to determine pain at specific points. Moreover, you can find out the nature of the injury yourself. It is enough just to slightly press on the area of the knee joint. If you feel discomfort, then you need to urgently visit the nearest medical facility.
Another hallmark injuries of this kind is hemoarthrosis, which can reach a fairly large size. The essence of this problem is an increase in the volume of the joint, which causes circulatory disorders. If something like this is noted, the specialist will have to urgently refer the patient to a puncture. This procedure will help remove the accumulated blood.

You can also determine the damage yourself by gently tapping your fingers on the axis of the lower leg. If you feel severe pain, then most likely the condyles are broken. Any movement in the injured knee will be accompanied severe pain. It is very difficult to find a position in which relief will come. If you try to change the position of the leg, you will immediately feel a new attack of soreness.

In a medical institution, specialists conduct x-rays in two projections. Pictures will help to establish the presence of damage, as well as assess its nature and complexity. If there is a displaced injury, the specialist will be able to see how far the debris has displaced.

Fracture treatment

Let us immediately clarify that the treatment of fractures of this kind is carried out directly in a medical institution. If an injury with displacement is diagnosed, the patient is sent for a puncture, which is necessary to remove the blood that has entered the joint. Once the procedure is performed, a firm fixation of the injured limb is required. Plastering is performed over the entire surface of the leg, starting from the fingers and ending with the gluteal fold. For some time, the patient is strictly forbidden any load on the injured limb.

During the recovery of a limb after a fracture, various methods are used. Let's consider the main ones.

Reduction of the leg. It will be required in order to restore the consistency of the condyles in the articular cavities.

Strong fixation. We mentioned this method just above. The leg is in a cast until the injury heals. The timing of treatment in this case is sometimes very different.

In some cases, specialists may prescribe an early load on the damaged joint. In this case, the cast will be removed, and the patient will need to gently bend and unbend the knee.

It is impossible to unequivocally describe the tactics of treatment for injuries of this kind. Injuries are different, so the approach in each case may not be the same. Specialists choose the method of dealing with trauma, depending on its complexity and type. So, if an incomplete fracture or damage of lesser severity is noted, the limb is fixed in plaster for a period of 21-30 days. As mentioned above, fixation is carried out from the upper thigh to the fingertips.

During treatment, the patient is strictly forbidden to walk even on crutches. The latter can be resolved no earlier than after the expiration of the leg fixation period. Also, specialists are able to use traction or simultaneous reduction.

For more severe cases, surgery is used. If there is a displaced fracture, the doctor will need to collect the fragments and set them in place. In this case, the period of stay of patients in a cast can greatly increase. It is strictly forbidden to refuse to fix the leg until the damaged area of the leg is completely healed.

A fracture of the condyle of the tibia is a very serious and severe injury. It is impossible to name unambiguous terms of recovery in this case. Additional measures, including rehabilitation, are appointed exclusively by a specialist.

The condyle is a thickening at the end of a bone to which muscles and ligaments attach. There are two of them on the tibia:

Medial (internal).
Lateral (external).

The condyles are a rather fragile part of the bone, because, unlike the bone itself, they are covered with cartilage. It is more elastic and much less resistant to all kinds of damage.

As we said above, the cause of injuries of this kind are falls from a height and landing on even legs. If something like this is noted, the condyles are strongly compressed and the dense section of the metaphysis is pressed into the spongy substance of the epiphysis.

Ultimately, the epiphysis is divided into two parts, due to which the outer and inner condyles simply break. A fracture may appear as two of these parts of the joint, or one of them.

You can tell them apart by one simple feature:

if the lower leg moves to the outside - problems with the external condyle;
if the lower leg moves inward, the internal condyle is broken.

The classification of injuries of this kind is quite extensive. First of all, complete and incomplete damage is distinguished. In the first case, a complete or partial separation of the condyle is noted. If the fracture is incomplete, then cracks, indentation may be noted, but separation is not observed. In general, injuries are divided into two large groups:

Fractures without displacement.
Displaced fractures.

Condyle injuries are often diagnosed with a number of concomitant injuries. These include trauma to the fibula, ruptures or tears of the knee ligaments, menisci, fractures of the intercondylar eminence.

Video: impression fracture of the posterior edge of the lateral condyle of the tibia

The medial and lateral condyles of the tibia are distinguished. Between them there is an intercondylar eminence that is not involved in the formation of the joint.

Along the intercondylar eminence are the anterior and posterior tibial spines, to which the cruciate ligaments are attached. The medial condyle has a concave surface and is larger than the convex lateral condyle.

The surface of the proximal part of the tibia in the sagittal plane is inclined downward at an angle of 10 degrees and in the direction from front to back. The condyles are lined with fibrocartilaginous menisci, which reduce the stress on the articular surfaces transmitted through the proximal tibia during movement.

Etiology and classification

According to the Schatzker classification, 6 types of tibial condylar fractures are distinguished. Type I - split fracture of the lateral condyle - type II - split fracture of the lateral condyle - type III - depressed fracture of the lateral condyle - type IV - fracture of the medial condyle - type V - fracture of both condyles - type VI - fracture of the condyles of the tibia extending to the diaphysis .

Diagnosis and symptoms of fractures of the condyles of the tibia

Examination of the knee joint reveals hemarthrosis. If, after radiography, the diagnosis of a fracture is doubtful, then a puncture of the knee joint is indicated, in which blood with fatty inclusions in the bone marrow can be obtained.

In the presence of V and VI types of fracture according to the Schatzker classification, as well as in case of damage to blood vessels, acute syndrome compression. In fractures of the condyles of the tibia, nerve damage mainly manifests itself in the form of neuropraxia.

Meniscal tears and cruciate ligament sprains and ruptures also occur.

Visual methods of research. If damage to the condyle of the tibia is suspected, an X-ray of the knee should be performed.

At the same time, for an adequate assessment of the nature of the fracture and the severity of the violation of the congruence of the articular surfaces, radiography is necessary in direct, lateral and axial projections.

Stress radiographs reveal damage to the collateral ligaments. Traction radiographs can help preoperative planning, allowing to assess the quality of reposition using the ligamentotaxis method.

CT may also be helpful in preoperative planning. If damage to the arteries is suspected, arteriography is necessary.

To assess the degree of damage to the menisci, as well as collateral and cruciate ligaments, you can use MRI.

The nature and timing of the operation are determined by the state of the knee joint, soft tissues, as well as vessels and nerves of the affected limb.

Surgical treatment is indicated for displaced injuries, fractures accompanied by an indentation of the articular surfaces of more than 4 mm, fractures accompanied by valgus or varus instability of the knee joint, determined at maximum knee extension, more than 10 degrees.

Intervention is indicated for a fracture associated with compression syndrome or vascular injury, with an open fracture, an injury associated with an ipsilateral diaphyseal fracture of the femur.

In the presence of a defect with displacement or indentation of the articular surfaces with the aim surgical treatment is the restoration of the articular surface. The depressed fragments are lifted, and the defects in the metaphysis are filled with a bone graft.

The condyles are stabilized with support plates. After reposition, arthroscopy allows assessing the congruence of the articular surfaces.

With a split fracture without displacement and limited repositioning by soft tissue damage, fragments can be fixed with lag screws. Comminuted fractures of type V, fractures of type VI, injuries accompanied by severe soft tissue damage may require additional fixation with hybrid external annular devices.

Additional fixation is also indicated in the presence of a severe comminuted fracture. If the fracture is accompanied by severe tissue edema, until it is eliminated, before surgery, you can use balanced suspension and skeletal traction of the limb.

Also, this method of treatment is indicated in the presence of severe concomitant diseases that are a contraindication to surgical treatment.

The operation also needs to repair associated injuries to the menisci or collateral ligaments. If the anterior cruciate ligament is torn off along with a fragment of the tibial spine, this fragment must be fixed in place.

If the anterior cruciate ligament is torn in its central part, reconstruction should be delayed until the fracture consolidates.

Complications of injury

Characteristic manifestations and diagnosis

It is not difficult to identify fractures of this kind. First of all, the specialist will pay attention to the characteristic symptoms of an injury, which include:

soreness;
hemoarthritis;
dysfunction of the joint;
deformation characteristic of such injuries;
lateral movements in the knee joint.

It should be noted that pain in condyle fractures may not correspond to the complexity of the injury. Therefore, when diagnosing a problem, palpation is performed - feeling the area of \u200b\u200bdamage.

Specialists do this in order to determine pain at specific points. Moreover, you can find out the nature of the injury yourself.

It is enough just to slightly press on the area of the knee joint. If you feel discomfort, then you need to urgently visit the nearest medical facility.

Another characteristic sign of injuries of this kind is hemoarthrosis, which can reach a fairly large size. The essence of this problem is an increase in the volume of the joint, which causes circulatory disorders.

If something like this is noted, the specialist will have to urgently refer the patient to a puncture. This procedure will help remove the accumulated blood.

You can also determine the damage yourself by gently tapping your fingers on the axis of the lower leg. If you feel severe pain, then most likely the condyles are broken.

Any movement in the injured knee will be accompanied by severe pain. It is very difficult to find a position in which relief will come.

If you try to change the position of the leg, you will immediately feel a new attack of soreness.

In a medical institution, specialists conduct x-rays in two projections. Pictures will help to establish the presence of damage, as well as assess its nature and complexity. If there is a displaced injury, the specialist will be able to see how far the debris has displaced.

Treatment of fractures of the condyles of the tibia

Let us immediately clarify that the treatment of fractures of this kind is carried out directly in a medical institution. If an injury with displacement is diagnosed, the patient is sent for a puncture, which is necessary to remove the blood that has entered the joint.

Once the procedure is performed, a firm fixation of the injured limb is required. Plastering is performed over the entire surface of the leg, starting from the fingers and ending with the gluteal fold.

For some time, the patient is strictly forbidden any load on the injured limb.

During the recovery of a limb after a fracture, various methods are used. Let's consider the main ones.

Reduction of the leg. It will be required in order to restore the consistency of the condyles in the articular cavities.
Strong fixation. We mentioned this method just above. The leg is in a cast until the injury heals. The timing of treatment in this case is sometimes very different.
In some cases, specialists may prescribe an early load on the damaged joint. In this case, the cast will be removed, and the patient will need to gently bend and unbend the knee.

It is impossible to unequivocally describe the tactics of treatment for injuries of this kind. Injuries are different, so the approach in each case may not be the same.

Specialists choose the method of dealing with trauma, depending on its complexity and type. So, if an incomplete fracture or damage of lesser severity is noted, the limb is fixed in plaster for a period of 21-30 days.

As mentioned above, fixation is carried out from the upper thigh to the fingertips.

During treatment, the patient is strictly forbidden to walk even on crutches. The latter can be resolved no earlier than after the expiration of the leg fixation period. Also, specialists are able to use traction or simultaneous reduction.

For more severe cases, surgery is used. If there is a displaced fracture, the doctor will need to collect the fragments and set them in place. In this case, the period of stay of patients in a cast can greatly increase. It is strictly forbidden to refuse to fix the leg until the damaged area of the leg is completely healed.

A fracture of the condyle of the tibia is a very serious and severe injury. It is impossible to name unambiguous terms of recovery in this case. Additional measures, including rehabilitation, are appointed exclusively by a specialist.

Conservative treatment indicated for injuries without displacement or with minimal displacement of fragments of the condyles of the tibia. The knee is immobilized in an orthopedic device and the patient is advised to avoid weight bearing for 4 weeks.

Movement is allowed in early dates. This is necessary for the prevention of stiffness and promotes the restoration of cartilage.

A fracture of the condyle of the knee joint is enough, requiring treatment. The knee joint is one of the most complex and largest joints in the human body, and it is also the most vulnerable to injury. The most common type of injury in the knee joint is a fracture of the condyles of the tibia or femur. Damage bone tissue joint refers to severe injuries, the treatment and correction of which requires effort, serious attitude and long-term rehabilitation.

Mechanisms and types of fractures

Understanding the mechanisms of injury is essential for diagnosing and treating it. Fractures of the condyles of the knee joint occur in the following situations:

Direct blows applied to the outer surface of the joint in a bent or extended state, such injuries are often obtained in car accidents.
Falls with a landing on a limb bent at the knee, lateral and straight surfaces of the joint.
Fall landing on straight legs.
Violent deviations or rotations of the lower leg also lead to such injuries.

Such injuries in life are common and, as a rule, lead to combined injuries, with damage to several bone structures at once, ligament ruptures, chondromalacia, or osteochondritis dissecans.

For reference! The complexity of the structure of the joint and the variety of damage mechanisms cause a variety of fractures, so you can find many classifications and types of fractures of the condyle of the femur or tibia, but the following injuries are clinically important.

Fracture of the condyle of the knee joint without displacement

It is characterized by a crack, a defect in the bone tissue. This type of fracture is treated by immobilization with a plaster cast for several weeks, full recovery occurs after 3-4 months.

Compression fractures of the condyles of the tibia

Occur by crushing on the condyle of the femur. This type of fracture is characterized by the relative preservation of the integrity of the synovial membrane, which does not give grounds for the development of arthritis. Also, with this fracture, there is less severe damage to the ligamentous apparatus. The prognosis in this case is good, and with timely seeking help, surgical intervention can be avoided.

Restoration of the level of the displaced and depressed condyle is achieved by manual reposition and subsequent fixation on the table with traction or normally applied plaster cast. Thus, the fragment is wedged and fixed in the knee joint.

As an example, a fracture of the lateral condyle of the tibia. There is a characteristic separation of a large fragment of the condyle, with its deviation, displacement to the outside by several mm, and fragmentation of the articular surface of the bone is also observed. This type of fracture is due to a slightly different position of the femur at the time of injury.

As a result hard hit femur on the articular surface of the tibia and its wedging and splitting of the condyle occurs. Usually, with this type of fracture of the lateral condyle of the tibia, the application of force falls on a small area, as a result, the head of the fibula is not injured, but is separated along with the chipped fragment of the tibial condyle by several mm.

The severity in this case may be different, it depends on the degree of damage to the ligaments and blood vessels. But usually there are complete ruptures of the ligaments, severe damage to the meniscus, which can be impressed into the tibial surface.

The cartilaginous base of the joint is damaged, which leads to arthritis and chondromalacia.
Damage to the vessels that feed the joint leads to insufficient blood supply to the articular structures, which is why tissue necrosis occurs in the future, this can result, for example, in osteochondritis dissecans. Predictions in this case are made cautiously.

Treatment and recovery in this case also involves the return of the chipped fragment to the anatomical position. This is also achieved different ways and depends on the severity of the fracture, as judged. In some cases, they are limited to manual reposition, but, as a rule, this is not enough. Then operative reposition is shown, if necessary, arthroplasty of damaged structures.

Fractures of the lateral and medial femoral condyles

Possible with violent and beyond the anatomical framework of abduction and adduction of the lower leg, as well as when falling on outstretched legs. Fractures of the lateral and medial condyle of the knee joint are also breaking off of a fragment or the entire condyle with a displacement of 3 mm or more, or without it. As a complication also dissecting osteochondritis.

Chondromalacia is a pathology of cartilage tissue, in which there is depletion, thinning and its destruction. With osteochondritis dissecans, detachment of a section of cartilage tissue from the bone is observed.

Important! Whatever type of fracture, its treatment should take place in a hospital, by doctors, since the time of treatment, the literacy of the doctor and proper treatment depends on its success and the exclusion of complications.

Symptoms appear almost immediately after a fracture, and they will help determine the type and complexity of damage:

appearance of a characteristic pain syndrome, with localization in the joint and thigh;
instability, excessive mobility of the patella;
feeling of instability, hesitation in the knee;
on palpation, pressing on the broken condyle of the knee joint causes severe sharp pain;
limitation and severe pain of movement in the joint;
crunch is characteristic, it is crepitus, on palpation, due to the presence of mobile bone fragments;
there will be swelling and swelling of the knee area, effusion in the articular cavity, which smoothes the outline of the joint.

Often, despite the presence of a fracture, patients successfully move on their own, and do not immediately go to the doctor, because it happens that there is no knee pain after an injury and a fracture.

Important! If there is a suspicion of a fracture, the presence of characteristic symptoms, a previous injury, you should immediately consult a doctor, because sometimes there may not be pain. Untimely access to a doctor may lead to the need for surgical intervention, which can be avoided if the fracture is fresh.

The doctor determines the severity of the fracture and subsequent treatment based on the results of an x-ray examination in the required projections.

Treatment

The treatment process is fundamentally different for patients with fractures with and without displacement.

First of all, with a fracture without displacement of the fragments, a puncture is shown, through which the effusion and blood in the joint cavity are removed. After that, a small amount of novocaine solution is introduced into the joint cavity, then the joint must be immobilized with a plaster cast. Having previously bent at the knee joint by 5-10 degrees, the limb is immobilized with a plaster bandage.

The term of imposition is about 2-3 months, after which, as a rehabilitation, physiotherapy exercises are necessary. It is important for the rehabilitation period to start training the thigh muscles. This is done literally 2-3 days after the bandage is applied by raising the limb. Later, after about 7-10 days, crutches are allowed, it is very important that there is no load on the joint.

Therapeutic measures for fractures with displacement of bone fragments may be different, but initially reposition is required, the return of displaced structures to their normal state:

Having determined the severity and type of fracture, the specialist performs manual reduction under anesthesia, fixes the upper part of the limb, manipulating the lower one. After that, an immobilizing plaster bandage is applied for the required period.
Also, the doctor may decide to treat with the method of constant traction, when the fragment is displaced by more than 3 mm. It implies a slow reduction of fragments, by applying a special splint to the limb and using a weight system. After a few weeks, if the reduction is successful, the traction system is changed to a plaster cast.

In the event that conservative methods do not give the desired effect or the fracture is quite complex, an operation is prescribed. Displaced fragments during the operation are fixed with bolts, while fusion also occurs for a long time, after which the screwed bolts are removed.