medial femoral condyle fracture treatment

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Department of Orthopaedic Surgery, Yaizu City Hospital, Shizuoka, Japan. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). Kilfoyle RM. J Orthop Surg (Hong Kong). Epub 2002 Sep 21. J Orthop Traumatol. All you need to do is just give us a call on 0410 559 856 and request an initial appointment. Subchondral insufficiency fracture of the knee: review of current [QxMD MEDLINE Link]. Yamamoto T, Bullough PG. [Treatment of medial epicondylar apophyseal avulsion injury in children]. J Orthop Trauma. This is not medical advice. Orthop. Without adequate nourishment, the affected portion of bone dies and gradually collapses. Bangil M, Soubrier M, Dubost JJ, Rami S, Carcanagues Y, Ristori JM, Bussiere JL. Unable to load your collection due to an error, Unable to load your delegates due to an error. The site is secure. The major controversy involving medial epicondyle fractures has involved the management of displaced fractures. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIzMTI5MC10cmVhdG1lbnQ=, Incarceration of the medial epicondyle fragment within the joint, Failure to recognize incarceration into the joint with functional loss. 2009;40 (2): 193-211. ), 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. Rev Rhum Engl Ed. Surgical treatment of femoral medial condyle fracture with lag screws 2007;14 (2): 112-6. 2700 Vikings Circle Femoral medial condyle fracture is a rare fracture. Zieliski R, Kozakiewicz M, Konieczny B, Krasowski M, Okulski J. 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. Both can sustain an injury and become fractured. Reduced fragment is marked. 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. 10 (2):e0438. A posterior splint is then applied for at least 7-10 days until ROM is initiated. 2010 Apr-May. 2010;18:597607. Unable to load your collection due to an error, Unable to load your delegates due to an error. and transmitted securely. [Full Text]. The femur is the longest bone in the body. Epub 2018 Jan 17. Arthrographic diagnosis of elbow injuries in children. [QxMD MEDLINE Link]. Materials (Basel). Displaced fractures of the medial humeral condyle in children. [QxMD MEDLINE Link]. Mirsky EC, Karas EH, Weiner LS. no financial relationships to ineligible companies to disclose. Recurrent bilateral insufficiency fracture of the talus. Before Before The patient had an uneventful postoperative recovery. Branches of the medial antebrachial cutaneous nerve should be identified and preserved. AVN of the epiphysis can be the result of loss of blood supply during an overaggressive soft-tissue dissection in attempts to achieve adequate exposure of the fracture. Diagnosis is made radiographically with CT studies often required to assess for intra-articular extension. Suggestive changes were seen on initial roentgenograms in only one case, whereas increased radionuclide uptake was a consistent finding on the bone scan. Check for errors and try again. J Bone Joint Surg Am. For nondisplaced or minimally displaced medial epicondyle fractures, nonoperative management is the procedure of choice. Bethesda, MD 20894, Web Policies Pellegrini Stieda Disease - StatPearls - NCBI Bookshelf Conclusion: Unable to load your collection due to an error, Unable to load your delegates due to an error. Chacha PB. 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. 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. The cause of medial and lateral femoral condyle fractures are mostly due to traumatic injuries, such as falling or jumping and landing from a great height. official website and that any information you provide is encrypted Postoperative radiographs confirmed anatomical reduction, and the patient achieved a good result. lt=""-/W3C/DTD XHTML 1.0 Strict/EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-s" title=""-/W3C/DTD XHTML 1.0 Strict/EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-s">. There are two femoral condyles. V. Distal humerus. Previous attempts to make it better provided only temporary relief. J. 1995 Jul-Aug. 15 (4):444-8. [QxMD MEDLINE Link]. Proximal tibia plate (Depuy Synthes: LCP proximal tibial plate 4.5) was placed upside down and fixed with cortical and locking screws. The degree of loss is usually minimal and does not decrease function. Pronation and supination are usually not affected. Bel J.C., Court C., Cogan A., Chantelot C., Pietu G., Vandenbussche E., SoFCOT Unicondylar fractures of the distal femur. Radiol Med. Subchondral insufficiency fracture of the knee (SIF/SIFK) are stress fracturesin the femoral condyles or tibial plateau that occur in the absence of acute trauma, typically affecting older adults. Pain due to bone insufficiency as a symptom heralding femoral neck fracture. A diagnostic pitfall for ankle pain. The https:// ensures that you are connecting to the Varma BP, Srivastava TP. Court-Brown C.M., Caesar B. Share cases and questions with Physicians on Medscape consult. 92 (17):2785-91. Similar functional results have been reported with operative and nonoperative surgical management. Lateral view after reduction. J Pediatr Orthop. 2015 Jul;19:95-102. doi: 10.1016/j.ijsu.2015.05.027. Accessibility Thank you for choosing Dr. LaPrade as your healthcare provider. Keywords: Features can vary depending on the stage and are best characterized on T2-weighted and proton density-weighted sequences. The proximal tibial plate could become the method of choice for such fractures. For nondisplaced or minimally displaced medial epicondyle fractures, nonoperative management is the procedure of. 3. Medial epicondyle fractures also may be treated in a closed fashion if the medial epicondyle is nondisplaced, minimally displaced, or even displaced up to 15 mm (see the image below). 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. Resistance of four fixation techniques used to treat subcondylar fractures. The following criteria apply to lesions without overlying cartilage abnormalities: in the weight-bearing area of the involved condyle, subtle flattening or a focal depressive deformity, an irregular, discontinuous hypointense line in the subarticular marrow, representing callus and granulation tissue, there may be a fluid-filled cleft within the subchondral bone plate (poor prognostic factor) 13, excavated defect of the articular surface (advanced cases), focal subchondral area of low signal intensity subjacent to the subchondral bone plate representing local ischemia (considered most important in early lesions and a specific MRI finding12), this area shows no enhancement on post-contrast; if it is thicker than 4 mm or longer than 14 mm, the lesion may be irreversible and may evolve into irreparable epiphyseal collapse and articular destruction, appears as a thickened subchondral bone plate, which represents a fracture with callus and granulation tissue and secondary osteonecrosis in the subarticular region 13, ill-defined bone marrow edemaand a lack of peripheral low signal intensity rim as seen in osteonecrosisand bone infarcts. Unauthorized use of these marks is strictly prohibited. Haxhija EQ, Mayr JM, Grechenig W, Hllwarth ME. These fractures account for approximately 40% of all femoral condylar fracture injuries. Knee Pain Location Chart Muscles of the Knee Hoffa Fat Pad, This is not medical advice. This website also contains material copyrighted by 3rd parties. In case of vertical fracture lines, screw fixation and buttress plates are necessary to achieve stability. sharing sensitive information, make sure youre on a federal International Journal of Surgery Case Reports. The plate was fixed provisionally and lag screw fixation was done with two cannulated cancellous screws. If the fragment is incarcerated in the joint, the incidence of ulnar nerve dysfunction can reach 50%. Thus, fractures to this structure are either a medial femoral condyle fracture or a lateral femoral condyle fracture. Excision of the fragment does not appear to yield results comparable to those of nonoperative treatment. Would you like email updates of new search results? Proximal tibia plate (Depuy Synthes: LCP proximal tibial plate 4.5) was placed upside down and fixed with cortical and locking screws. Positioning for valgus stress radiograph. Femoral Condyle Cartilage Defect Treatment: Treatment of cartilage defects of the femoral condyles requires a thorough workup and ensuring that the defects are truly symptomatic. Are you recovering from a fractured femoral condyle? This type of surgery is considered the gold standard because the cartilage has an excellent chance of healing and if one follows a proper rehabilitation program with low impact activities only for the first year after implantation, there are excellent outcomes described in the literature for this procedure. Leet AI, Young C, Hoffer MM. Chap 17. Acta Orthop Scand. 28 (2):2309499020921755. If there is a fracture (break) in part of the condyle, this is known as a fracture of the femoral condyle. IS attended the surgery, and all authors read this paper. Fracture of the medial condyle of the humerus in an elderly patient. 1980 Oct. 62 (7):1159-63. Cavalieri-Pereira L, Spagnol G, Sverzut CE, de Moraes M, Trivellato AE. Microsurgery. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. The authors declare that there is no conflict of interests regarding the publication of this paper. To date, however, no consensus exists regarding the optimal implant due to few cases [2]. Isaku Saku is the corresponding author of this paper. 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. Orthop. Also known as a bone marrow lesion, BME occurs when arthritis, an injury, or a fracture damages the normal bone structure. The anatomical plate for distal medial condyle fracture of femur should be developed as soon as possible. More controversy exists with displacement of 5-15 mm. Orthop. I am so glad I did! [Full Text]. An avulsion fracture occurs when a small chunk of bone attached to a . J Bone Joint Surg Am. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Pellegrini-Stieda lesions are ossified post-traumatic lesions at (or near) the medial femoral collateral ligament adjacent to the margin of the medial femoral condyle.

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