tibial condyle fractures

$: Tibial condyle fractures$

Muscle Attachments

› TFL – Gerdy’s tubercle

› Patellar tendon – Tibial tuberosity

› Sartorius + Gracillis + Semitendinosus – Pes

Anserinus.

› Semimembranosus(Horizontal head) –

Medial Condyle.

› Biceps femoris – small slip to lateral condyle

Articular surface

› Medial condyle bigger than Lateral condyle

› Medial condyle concave in both coronal

and saggital axes.

› Lateral condyle convex in both coronal and

saggital axes.

1 % of all fractures

8 % of all fractures in elderly

Lateral condyle # - 55 – 70%

Medial condyle # - 10 – 25%

Bicondylar # - 10 – 30%

Open # - 1-3%

Varus or valgusforce with axial loading in fully extended or partially flexed knee.

A result of high energy trauma in adults.

A result of tivialfall in osteopenicelderly.

Pain

Swelling & Haemarthroses knee

Inability to bear weight

Restricted mobility

Instability

Deformity Around the Knee

Pale, Cool Foot

Neurovascular injury

Compartment syndrome

DVT

Contussion & crush injury with open

wounds.

Ligamentous injury – more with #

dislocation pattern (60%) as compared

to pure # pattern (4-33%)

Given by Tscherne & Lobenhoffer in

association with # dislocation patterns.

› Meniscal injuries – 67%

› MCL injury – 85%

› Cruciate ligaments injury – 96%

Palpation

1.Elicit tenderness.

2.Any Ligamentous disruption.

Careful neurovascular examination is

done

Skin condition

Pulses


X-rays

› Antero posterior

› Lateral

› Oblique

› Beam at a 10 degree angle caudally

Computed tomography.

Magnetic Resonance Imaging.

•Moore and Hohl classification of

primary # pattern

AO classification

Schatzker’s classification

Type -1› 4-6%› Valgus force + Axial loading

Type – 2› 60-75%› Valgus force

Type – 3› Very rare› Pure compression

Type – 4› 7-10%› High energy varus force +/- Axial loading

Type – 5› 2-3%› High energy complex varus and valgus force

Type – 6› 16-20%› High energy complex varus and valgus force

Goals

›Restore articular congruity.

›Axial alignment.

›Joint stability.

›Functional motion at knee.

Indications

› Unstable # + ligament injury + articular

displacement

Instability - > 10 degrees of varus or valgus

Depression or displacement > 10 mm

› Open #

› # with compartment syndrome

› # with vascular injury

Tscherne and lobenhoffer recommended surgical reduction of fractures with more than 2mm of articular incongruity

Bennet and Browner >5 mm of joint displacement or >5 mm degree of axial malalignment indication of operative treatment

If depression or displacement › <5 mm in stable fracture non operative treatment is

considered

› If 5to 8 mm –

Age

Motion demands

› >10 mm - surgical fixation.

1. Percutaneous screw fixation

› Indications - Nondisplaced type I fractures

› Advantages - Simple technique with minimal

soft-tissue injury.

› Disadvantages - Not applicable for other

patterns of fracture.



soft-tissue injury.


› Disadvantages - Not applicable for other

patterns of fractures.

2. Percutaneous elevation and screw

fixation

› Indications - Type II and III fractures in

osteoporotic bone.


fixation


soft-tissue injury.


fixation

› Disadvantages - Not useful for high-energy

fractures with ligamentous and meniscal

injuries.

3. Arthroscopic-assisted elevation and

screw fixation

› Indications - Types I, II, III, and IV fractures

with ligamentous and meniscal injuries.


screw fixation

› Advantages –

Minimal soft-tissue injury.

Helps to diagnose and treat intra-articular

injuries.

Aids in reduction of depressed articular

fractures.

Allows for joint lavage.


screw fixation.

› Disadvantages - Not useful in high-energy

fractures

4. Open reduction and internal fixation with

or without bone grafting.

› Indications - Types II,III, IV, V, and VI fractures

without soft-tissue injury.

4. Open reduction and internal fixation

with or without bone grafting.

› Advantages –

Allows anatomic reduction.

rigid internal fixation and bone grafting.

facilitates joint exploration and treatment of

intra-articular injuries.

4. Open reduction and internal fixation

with or without bone grafting.

› Disadvantages –

Should not be performed in the acute setting

in the presence of soft-tissue injury.

unnecessary for type I fractures

5. External fixators - Half-pin fixator, ring

fixator, hybrid fixator

› Indications –

Open injuries and high-energy (types IV, V,

and VI) fractures with soft-tissue injury.

fractures with vascular injury with or without

compartment syndrome.

polytrauma patients



› Advantages –

Minimal soft-tissue injury.



› Disadvantages –

Nonrigid fixation.

difficult to achieve anatomic fracture

reduction.

joint stiffness.

pin-tract infections.

septic arthritis.

Recovering range of motion is a challenge for patients who› cannot actively participate in rehabilitation,

› may have soft-tissue injuries that preclude immediate range of motion, and

› have had external-fixation pins inserted near their quadriceps. .

Motion is restricted until surgical and traumatic wounds are dry.

Continuous passive motion begins when wounds are dry; the goal is full extension and 90° of flexion within 5-7 days.

If other injuries allow, the patient is mobilized with a hinged brace locked in extension for 6 weeks.

Non – weight-bearing precautions

generally continue for 12 weeks.

Active flexion and passive extension are

encouraged for 6 weeks, after

which active knee extension is started.

Early complications


Vascular injuries

Swelling and wound-healing problems

Infections

Deep vein thrombosis

Late complications

Knee stiffness

Knee instability

Angular deformities

Late collapse

Malunion

Post traumatic arthritis

tibial condyle fractures

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