medial femoral condyle fracture treatment

We used a locking compression plate - proximal tibial plate 4.5/5.0 (Depuy Synthes TRAUMA) as a buttress plate. This article discusses anatomic considerations, classification of condylar fractures, indications for surgery, treatment options, and complications. Imaging showed failure of the medial femoral condyle to incorporate with talar fragmentation. Fotiadou A, Karantanas A. To our knowledge there have been no previous reports of stress fractures of the medial femoral condyle. Fractures and other serious injuries to the knee can result in damage to nearby nerves, blood vessels and other musculoskeletal structures, causing chronic pain or permanent injury. EDINA- CROSSTOWN OFFICE 2010 Apr-May. Before The condyle fragment is then reduced and secured at a minimum of two sites to prevent rotation. An incidental finding on MRI scan may not need treatment, and close observation may be indicated in these cases. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. It occurs more frequently in females, and the medial femoral condyle is the most common location, due to a more limited intraosseous blood supply, with watershed areas, as opposed to the lateral femoral condyle. Oral Maxillofac Surg Clin North Am. International Journal of Surgery Case Reports. Iowa Orthop J. MeSH Long-term functional assessment has demonstrated similar results even with radiographic nonunion being apparent on most of the fractures treated nonoperatively. 1997 Nov. 5 (6):303-312. The https:// ensures that you are connecting to the Su HC, Chou SH, Ho HY, Lu CC, Tien YC, Shih CL, et al. Case presentation 2010;29: 38-42. Please let our friendly reception staff know the background and severity of your condition. Catgut suture as a means of internal fixation has proved to be inadequate, in that it has often resulted in this complication. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. [QxMD MEDLINE Link]. Operative strategy in postero-medial fracture-dislocation of the proximal tibia. National Library of Medicine Treatment options include loose body removal, microfracture, multiple internal fixation and so on. Subchondral hypointense fracture lines tend to resolve with conservative therapy. An official website of the United States government. . 2006 Jun. [QxMD MEDLINE Link]. A longitudinal incision is made over the medial supracondyle ridge of the humerus and continued just distal to the medial condyle. These are fractures that occur in the coronal plane rather than the more common sagital plane. J. We gained access to the joint through the medial parapatellar approach, anatomical restoration of the joint surface was achieved with clamp application. 32 Suppl 1:S10-3. Diagnosis is made radiographically with CT studies often required to assess for intra-articular extension. Treatment for most patients is with a rehabilitative course consisting of range-of-motion and stretching exercises of the knee joint and medial collateral ligament. Epub 2011 May 4. 30 (3):253-63. FOIA Yates PJ, Calder JD, Stranks GJ et-al. This paper reports just the record of patient treatment. The longer the inactivity and immobility the longer the recovery and rehabilitation is likely to take. The https:// ensures that you are connecting to the Careers. (2019) Skeletal radiology. Lateral view after reduction. Bookshelf Dodds SD, Flanagin BA, Bohl DD, DeLuca PA, Smith BG. MR appearance of SONK-like subchondral abnormalities in the adult knee: SONK redefined. Attachment of medial collateral ligament components is pictured. 48 (3):199-201. Epidemiology of adult fractures: a review. Our clinics are open: In this case, replacing both of the bone and cartilage would be indicated. Epub 2016 May 20. Ip D, Tsang WL. Editorially reviewed, not externally peer-reviewed. 2001 Sep. 83 (9):1299-305. Kilfoyle RM. The innervation of the medial humeral epicondyle: implications for medial epicondylar pain. Positioning for valgus stress radiograph. He offers. A 80-year-old woman fell down 15 steps at her home and reported to our hospital with severe right knee pain. and transmitted securely. [QxMD MEDLINE Link]. Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. Bookshelf Jegan Krishnan, MBBS, FRACS, PhD Professor, Chair, Department of Orthopedic Surgery, Flinders University of South Australia; Senior Clinical Director of Orthopedic Surgery, Repatriation General Hospital; Private Practice, Orthopaedics SA, Flinders Private Hospital Discussion: Cartil. How displaced are "nondisplaced" fractures of the medial humeral epicondyle in children? J. Surg. NCI CPTC Antibody Characterization Program, Court-Brown C.M., Caesar B. Swelling can occur and bruising in many cases. ), identifies vascular segments with diminished flow, displaced distal femur fractures may result in injury to the, patient with significant comorbidities presenting an unacceptably high degree of surgical/anesthetic risk, variable and dependent on multiple factors including patient characteristics and fracture pattern, temporizing measure to restore length, alignment, and stability, soft tissues not amenable to surgical incisions and internal fixation, or until the patient is stable, contamination requiring multiple debridements, variable and dependent on multiple factors including patient characteristics, fracture pattern, and degree of soft tissue injury, 92-100% union rates reported at an average of 4-6 months when used as definitive treatment, traditional 95 degree devices contraindicated in Hoffa fractures, periprosthetic fracture with osteoporotic bone, fixed-angle plates required for metaphyseal comminution, non-fixed angle plates are prone to varus collapse, dual plating (lateral + medial plate) offers greatest degree of axial and torsional stiffness, no difference in fixation failure, reoperation rates, or nonunion with early weightbearing as tolerated and protected weightbearing in extra-articular distal femur fractures, periprosthetic fractures with implants with an "open-box" design, distal femoral replacements do not allow retrograde nail fixation, traditionally, 4 cm of intact distal femur needed but newer implants with very distal interlocking options may decrease this number, independent screw stabilization of intraarticular components placed around nail, high union rates reported, more symmetric callus formation compared to plates, reduced rates of malunion and higher patient satisfaction compared to ORIF has been reported, preexisting osteoarthritis with amenable fracture pattern, fracture around prior total knee arthroplasty with loose component, may have improved ambulatory status and decreased nonunion compared to other methods of fixation, reduced longevity compared with internal fixation, restricted weight-bearing until evidence of fracture union, serial radiographs to assess for displacement, avoid pin placement in the area of planned plate placement, if possible, arthrotomy for direct reduction of articular components, best when used for extraarticular fractures, distal incision large enough to insert plate sub-muscularly, screws placed through smaller proximal incisions, midline anterior incision that angles slightly lateral, facilitates articular and lateral distal femur exposure, fractures with complex articular extension, extend incision into quadriceps tendon to evert patella, used for complex medial femoral condyle fractures, most often used for type B2 and B3 patterns, can be used to augment fixation with medial plate in type C3 patterns, used for very posterior Hoffa fragment fixation, midline incision over the popliteal fossa, develop a plane between medial and lateral gastrocnemius, restore articular surface before fixation of extraarticular component, stable fixation of articular component to diaphysis for early ROM, direct visualization of the joint allows perfect reduction of intraarticular fractures with lag screw fixation before attaching the articular block to the proximal fragment, allows better control of coronal plate compared to 95 angled blate plate and dynamic condylar screw, multi-plane screw trajectory allows fixation of, lag screws with locked screws (hybrid construct), intercondylar fractures (usually in conjunction with locked plate), locking screw constructs don't rely on bone-plate contact for stability, helpful when pre-contoured plates do not precisely match patient anatomy, potential to create too stiff of construct leading to nonunion or plate failure, NOT an appropriate construct for isolated medial femoral condyle fractures, requires precise initial implantation of the blade into the distal fragment, may provide poor fixation osteoporotic bone, precise sagittal plane alignment is not necessary as plate rotates around the barrel, large amount of bone removed, may provide poor fixation in osteoporotic bone, mid substance longitudinal patellar tendon split, 2.5 cm incision parallel to medial aspect of patellar tendon, no attempt to visualize articular surface, incise extensor mechanism 10 mm medial to the patella, eversion of patella not typically necessary, need to stabilize articular segments before nail placement, articular reduction and fixation before nail placement, lag screws placed out of the intended IMN path, starting point at the superior margin of Blumensaat line (lateral) and center of intercondylar notch (AP), blocking screws facilitate reduction and strengthen the construct, implant should reach lesser trochanter to reduce risk of vascular injury, IMN for periprosthetic fractures may result in, resect fracture to allow full weight-bearing, endoprosthetic metal or polyethylene component fracture, excessively long screws can irritate medial soft tissues, determine appropriate intercondylar screw length by obtaining an AP radiograph of the knee with the leg internally rotated 30 degrees, rotation, hyperextension (recurvatum), and coronal malalignment, percutaneous submuscular fixation with pre-contoured locking plate, malalignment is more common with IM nails, revision internal fixation with osteotomy, functional results satisfactory if malalignment is within 5 degrees in any plane, up to 19%, most commonly in metaphyseal area with articular portion healed (comminution, bone loss and open fractures more likely in metaphysis), associated with soft tissue stripping in metaphyseal region, consider changing fixation technique to improve biomechanics, hardware removal if fracture stability permits, stainless steel implants may be inferior to titanium, plate fixation associated with toggling of distal non-fixed-angle screws used for comminuted metaphyseal fractures, associated with short plates and nonlocked diaphyseal fixation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. J Pediatr Orthop. At the time the article was created Frank Gaillard had no recorded disclosures. Epicondyle fractures can be caused by traction forces. Institutional review board approval was not required because all data were collected from clinical records and imaging systems for routine preoperative planning and follow-up. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. Although the plate needed bending to achieve congruence, it fit well and yielded a good clinical outcome. Functionally, no limitation from this radiographic finding appears to exist. Long-term osseous sequelae after acute trauma of the knee joint evaluated by MRI. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. 8. 16. American journal of roentgenology. Anteroposterior view of displaced medial epicondyle fracture after reduction. Plain radiography and computed tomography. [QxMD MEDLINE Link]. Unable to load your collection due to an error, Unable to load your delegates due to an error. HHS Vulnerability Disclosure, Help Contact Vitalis Physiotherapy now to book in your treatment. Please confirm that you would like to log out of Medscape. Some have suggested conservative treatment for fractures older than 4 weeks, whereas others have demonstrated some restored function in treating these fractures at the time of delayed diagnosis, though the results are imperfect. Nomenclature of Subchondral Nonneoplastic Bone Lesions. The .gov means its official. Because some cases of primary osteonecrosis may be secondary to undiagnosed stress-related microfractures, early diagnosis and elimination of weight bearing are essential. 2019 Aug. 45 (4):757-761. Orthop. It is almost always unilateral, usually affects the medial femoral condyle (but can occasionally involve the tibial plateau 9) and is often associated with a meniscal tear. A radiographic nonunion of the medial epicondyle fracture fragment associated with nonsurgical treatment was not found to have any functional impairment in at least one long-term study. Partial or complete recovery may take months. For nondisplaced or minimally displaced medial epicondyle fractures, nonoperative management is the procedure of. Femoral medial condyle fracture is a rare fracture. Femoral medial condyle fracture is a rare fracture. In fractures with a vertical fracture line, a buttress plate is necessary to counteract the vertical shear forces. One such maneuver (the Roberts manipulative technique) is performed under sedation and involves placing a valgus stress on the elbow while supinating the forearm and simultaneously dorsiflexing the wrist and fingers to place the forearm flexor muscles on stretch. Surgery can consist initially of cleaning up the rough edges and seeing how the patient does. Lotke PA, Nelson CL, Lonner JH. As with any articular injury, anatomical restoration of the joint surface must be obtained, then lag screw fixation is required. North Am. (2019) AJR. McDonald T.C., Lambert J.J., Hulick R.M., Graves M.L., Russell G.V., Spitler C.A. National Library of Medicine A lag screw is then placed to maintain and compress the fracture fragment. [44] with a thickening deformity at the fracture site can occur with inadequate reduction, fixation, or immobilization. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. Dhillon M.S., Mootha A.K., Bali K., Prabhakar S., Dhatt S.S., Kumar V. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. The fracture surfaces are identified and cleaned, and the joint space is cleaned and irrigated to remove loose particles. [QxMD MEDLINE Link]. These lesions may be underdiagnosed since they are easily mistaken for primary osteonecrosis in the absence of magnetic resonance imaging. Distal femur fractures are traumatic injuries involving the region extending from the distal metaphyseal-diaphyseal junction to the articular surface of the femoral condyles. 2010 May. Impaction Fracture of the Medial Femoral Condyle assessment of the anterior cruciate liga-ment with the anterior drawer and Lach-man tests was negative for laxity. Informed consent was obtained for the surgery. We used a proximal tibial plate upside down as a buttress plate for femoral medial condyle fracture. Here, we report a case of femoral medial condyle fracture treated with lag screws and proximal tibial plate as a buttress plate. -. Intraobserver and interobserver agreement in the measurement of displaced humeral medial epicondyle fractures in children. J Orthop Trauma. Rev Rhum Engl Ed. 14. Unable to load your collection due to an error, Unable to load your delegates due to an error. You will likely be referred for CT, X-ray or MRI scans to determine the extent of the injury. Medial humeral epicondylar fracture in children and adolescents. 2000 Mar-Apr. For more information on femoral condyle conditions and the available treatment options for your knee pain, please contact the offices of Dr. Robert LaPrade, serving patients from the Twin Cities, Minneapolis-St. Paul, Edina and Eagan, MN. J Pediatr Orthop. 2014;100:873877. Surgical techniques and a review of the literature. History Mystery: Did Subdural Hematoma Kill Thomas Aquinas? Primary osteonecrosis of the femoral condyle shares several features with insufficiency fractures, including predominance in elderly women with factors responsible for mechanical stress (varum, obesity, trivial trauma), mechanical pain, and increased radionuclide uptake. 7 Subchondral fractures also occur in the lateral femoral condyle or tibial plateau. Atlas Oral Maxillofac Surg Clin North Am. The femoral condyles are the lower part of the femur where the shaft widens to two condyles, one medial and one lateral. 1965 Jul-Aug. 41:43-50. 2022 Mar;53(3):1237-1240. doi: 10.1016/j.injury.2021.11.034. FOIA In preparation for ORIF, the arm is placed in a posterior splint for stabilization, elevated, and treated with ice packs to decrease swelling. Treatment of distal femur fractures with the DePuy-Synthes variable angle locking compression plate. Edmonds EW. Nondisplaced medial condyle fractures can be treated without surgery. 2020 Nov-Dec;11(6):1072-1081. doi: 10.1016/j.jcot.2020.10.013. Schematic of two types of medial condyle fractures, as described by Milch. Elbow dislocation associated with medial epicondyle fracture. Following this period of healing, knee range of movement will need to be recovered as it will have reduced due to immobility of the joint. Louahem DM, Bourelle S, Buscayret F, Mazeau P, Kelly P, Dimeglio A, et al. Salter-Harris type IV medial condyle fractures with 2 mm or more of displacement usually must be treated by means of open reduction with internal fixation (ORIF). The fragment is usually displaced distally and anteriorly. Bookshelf The patient complained of severe pain in the right knee and could not move her knee. The patient had an uneventful postoperative recovery. [QxMD MEDLINE Link]. [Full Text]. 2011 Oct;42(10):1060-5. doi: 10.1016/j.injury.2011.03.041. [QxMD MEDLINE Link]. In case of vertical fracture lines, screw fixation and buttress plates are necessary to achieve stability. Protective splinting may be continued for 3 weeks if necessary. The post-operative plain radiography and computed tomography. Skeletal Radiol. Endoscopically assisted management of mandibular condylar fractures. This was treated with a supracondylar wedge osteotomy to restore ROM and correct the cubitus varus deformity. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). It was first systematically described by Ahlbck in 1968 2. Internal fixation allows this early physical therapy to be instituted without compromising the reduction. 1987 Jul-Aug. 7 (4):421-3. For bicondylar fractures, a median parapatellar incision can be used. The medial aspect of the knee, and specifically the descending genicular artery (DGA), was first recognized as a potential donor site for a vascularized flap in 1981 [].In 1985, the osteoarticular branch (OAB) of the DGA was realized as a flap supply source in harvesting the adductor magnus tendon and tubercle [].The contemporary medial femoral condyle (MFC) flap was first described in 1988 as . If the epicondyle is fragmented, excision of the fragment and fixation of the flexor-pronator origin and medial collateral ligament (MCL) to bone with an alternative form of fixation (eg, suture anchors) may be used. 2015 Feb. 27 (1):58-66. Takeda M, Higuchi H, Kimura M et-al. Sayyid S, Younan Y, Sharma G, Singer A, Morrison W, Zoga A, Gonzalez FM. 1997 Feb-Mar. 2007;14 (2): 112-6. Murphy C.G., Chrea B., Molloy A.P., Nicholson P. Small is challenging; distal femur fracture management in an elderly lady with achondroplastic dwarfism. Symptoms are similar to those of any fracture. Before Late reconstruction of condylar neck and head fractures. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. Skeletal Radiol. Fernandez FF, Vatlach S, Wirth T, Eberhardt O. Medial humeral condyle fracture in childhood: a rare but often overlooked injury. Pape D, Seil R, Kohn D et-al. Bethesda, MD 20894, Web Policies Case report, Femoral medial condyle fracture, Proximal tibial plate, Surgery, Knee. Skeletal Radiol. [Full Text]. Here, we present a case with femoral medial condyle fracture treated with a proximal tibial plate. The fracture was intra-articular and simple oblique through the notch (AO classification: 33-B2.1). At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: Reduce Pain Restore Movement Optimise Recovery What are Femoral Condyle Fractures? for: Medscape. Clinically Oriented Anatomy. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture. Proximal tibia plate (Depuy Synthes: LCP proximal tibial plate 4.5) was placed upside, The post-operative plain radiography and. 8600 Rockville Pike Maugars Y, Dubois F, Berthelot JM, Dubois C, Prost A. Lafforgue P, Pham T, Denizot A, Daumen-Legr V, Acquaviva PC. Microsurgery. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. When the loss is related to another complication, such as nonunion, malunion, or heterotopic ossification, it can be significant. At the time the article was last revised Yuranga Weerakkody had This site needs JavaScript to work properly. There has been disagreement regarding how to manage a fracture that has remained untreated for several weeks or longer. For fractures treated with ORIF, the arm should be put in a cast in 90 of flexion for 3 weeks and then placed in a posterior mold for 3 weeks with supervised active flexion and extension out of the mold. Dependant on the injury the fracture may be close, meaning the skin is not broken or, open where the bone protrudes through the skin. Mirsky EC, Karas EH, Weiner LS. If there is a fracture (break) in part of the condyle, this is known as a fracture of the femoral condyle. Orthop. 2020 Jan. 26 (1):137-143. There will be a sudden onset of severe pain, and inability to weight bear on that leg. The second involves ulnar nerve dysfunction, which may occur in 10-16% of cases. We used lag screw fixation and plating with proximal tibial plate for the same side as a buttress plate to counteract the vertical shear forces. Bel J.C., Court C., Cogan A., Chantelot C., Pietu G., Vandenbussche E., SoFCOT Unicondylar fractures of the distal femur. [Posttraumatic temporomandibular joint ankylosis: clinical development and surgical management]. 2018 Mar;22(1):91-96. doi: 10.1007/s10006-018-0675-0. Leet AI, Young C, Hoffer MM. Surg. This is called a chondroplasty. The ulnar nerve is identified and protected and may be transposed anteriorly. government site. The force of this event may even fracture other bones within the knee or legs. Fracture of femoral condyle can occur, although it is a rare injury. J Clin Orthop Trauma. 2009;114 (3): 437-47. In case of vertical fracture lines, screw fixation and buttress plates are necessary to achieve stability. Results of a three-dimensional computed tomography analysis. At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: The knee comprises of the thigh bone (femur), the kneecap (patella) and the shin bone (tibia) joining together. Case presentation: The proximal tibial plate could become the method of choice for such fractures. PMC Contact us to make an appointment. Fracture of the medical condyle of the humerus with rotational displacement. In this lateral view, fragment is marked with circle. Olecranon acting as a wedge and creating medial condyle fracture. Initially, the arm should be splinted in 90 of elbow flexion. Yates C, Sullivan JA. At the latest follow-up, the patient achieved a range of motion of 0 to 120 and could walk without pain. [QxMD MEDLINE Link]. MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis. [Full Text]. Nevertheless, there are no available anatomical plates that fit either the femoral medial condyle or fracture fixation, except for the relatively short plate developed for distal femoral osteotomy. Gentle active range-of-motion (ROM) exercises may begin within 1 week after injury. Diagnostic imaging will be necessary and acute treatment of rest, ice, medication and in some cases surgery. Two days after the injury, we performed an open reduction and internal fixation using locking compression plate for proximal tibia and lag screws. These fractures account for approximately 40% of all femoral condylar fracture injuries. Harrison RB, Keats TE, Frankel CJ, Anderson RL, Youngblood P. Radiographic clues to fractures of the unossified medial humeral condyle in young children. Mon - Fri: 8am - 8pm Note normal location somewhat posteriorly on distal humerus. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. If the patient is unable to tolerate a long surgical procedure because of polytrauma, closed reduction and cast immobilization with 90 of flexion is an option. This immobilization must be balanced against the need for physical therapy to prevent loss of ROM. Karlsson MK, Herbertsson P, Nordqvist A, Besjakov J, Josefsson PO, Hasserius R. Comminuted fractures of the radial head.

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