Medial condyle of the tibia fracture. Fractures of the tibial condyles: types, treatment. More about varieties

The condyle is a thickening at the end of a bone to which muscles and ligaments are attached. 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 tissue. 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 straight legs. If something like this is noted, the condyles are strongly compressed and the dense part of the metaphysis is pressed into the spongy substance of the epiphysis.

Ultimately, the epiphysis divides into two parts, causing the external and internal condyles to simply break. A fracture may appear to occur in two of the specified parts of the joint, or in just one.

You can distinguish them by one simple sign:

if the tibia moves outward, there are problems with the external condyle;
if the tibia moves inward, the internal condyle is broken.

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

Fractures without displacement.
Displaced fractures.

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

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

The medial and lateral condyles of the tibia are distinguished. Between them there is an intercondylar eminence that does not participate 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 anterior-posterior direction. The condyles are covered by fibrocartilaginous menisci, which reduce the load on the articular surfaces transmitted through the proximal tibia during movement.

Etiology and classification

According to Schatzker's classification, there are 6 types of fractures of the tibial condyles. Type I - split fracture of the lateral condyle - type II - split depressed 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 tibial condyles extending into the diaphysis .

Diagnosis and symptoms of fractures of the tibial condyles

When examining the knee joint, hemarthrosis is detected. If, after an x-ray, the diagnosis of a fracture is doubtful, then a puncture of the knee joint is indicated, during which blood with fatty inclusions of the bone marrow can be obtained.

In the presence of types V and VI of fracture according to the Schatzker classification, as well as in case of vascular damage, acute compartment syndrome may develop. In fractures of the tibial condyles, nerve damage mainly manifests itself in the form of neuropraxia.

Meniscus tears and cruciate ligament sprains and tears also occur.

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

At the same time, to adequately assess the nature of the fracture and the severity of the violation of congruence of the articular surfaces, radiography in direct, lateral and axial projections is necessary.

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

CT scanning may also be useful in preoperative planning. If arterial damage is suspected, arteriography is necessary.

The degree of damage to the menisci, as well as collateral and cruciate ligaments can be assessed using MRI.

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

Surgical treatment is indicated for a displaced injury, a fracture accompanied by depression of the articular surfaces of more than 4 mm, a fracture accompanied by valgus or varus instability of the knee joint, determined at maximum knee extension of more than 10 degrees.

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

If there is a defect with displacement or depression of the articular surfaces, the goal of surgical treatment is to restore the articular surface. The depressed fragments are lifted, and the defects in the metaphysis are filled with bone graft.

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

In case of a split fracture without displacement and the possibilities of reposition limited by soft tissue damage, the fragments can be fixed with lag screws. Comminuted type V fractures, type VI fractures, and injuries involving severe soft tissue damage may require additional fixation with hybrid external ring devices.

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

This method of treatment is also indicated in the presence of severe concomitant diseases that are a contraindication to surgical treatment.

During surgery, it is also necessary to eliminate concomitant damage to the menisci or collateral ligaments. If the anterior cruciate ligament is torn along with a fragment of the tibial spine, this fragment must be fixed in place.

If the anterior cruciate ligament is torn centrally, reconstruction should be delayed until the fracture has healed.

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 injury, which include:

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

It should be noted that the pain associated with condylar fractures may not correspond to the complexity of the injury. Therefore, when diagnosing a problem, palpation is performed - feeling the area of damage.

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

It is enough to just apply light pressure on the knee joint area. 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 quite large sizes. The essence of this problem is the increase in volume of the joint, which causes circulatory problems.

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

You can also determine the damage yourself by gently tapping your fingers along the axis of the shin. If you feel severe pain, it means that the condyles are most likely broken.

Any movement in the injured knee will be accompanied by severe pain. Finding a position that brings relief is very difficult.

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

In a medical institution, specialists perform radiography in two projections. The photographs will help determine the presence of damage, as well as assess its nature and complexity. If a displacement injury occurs, the specialist will be able to see how far the debris has shifted.

Treatment of fractures of the tibia condyles

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

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

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

Various methods are used to restore a limb after a fracture. Let's look at the main ones.

Realignment of the leg. It will be necessary to restore the alignment of the condyles in the glenoid sockets.
Strong fixation. We mentioned this method a little higher. The leg is in a cast until the injury heals. The timing of treatment in this case can sometimes vary greatly.
In some cases, specialists may prescribe early loading on the damaged joint. In this case, the plaster will be removed, and the patient will need to carefully bend and straighten the knee.

It is impossible to unambiguously describe treatment tactics for injuries of this kind. Injuries can be different, so the approach in each case may be different.

Specialists choose a method of dealing with injury depending on its complexity and type. So, if an incomplete fracture or damage of lesser severity is noted, the limb is fixed in a cast 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 permitted no earlier than after the leg fixation period has expired. Specialists are also able to use traction or immediate reduction.

For more severe cases, surgery is used. If a displaced fracture is noted, the doctor will need to collect the fragments and set them in place. In this case, the length of time patients stay in a cast can greatly increase. Refusing to fix the leg until the damaged area of the leg has completely healed is strictly prohibited.

A fracture of the tibial condyle is a very serious and serious injury. It is impossible to give an unambiguous time frame for recovery in this case. Additional measures, including rehabilitation, are prescribed exclusively by a specialist.

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

Movements are allowed early. This is necessary to prevent stiffness and promote cartilage restoration.

An impression fracture of the femoral condyle is one of the most severe injuries. The condyle is the outermost part of the bone that connects it to muscles and ligaments.

There are 2 condyles on the femur: external and internal. Considered to be a fragile part.

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Depressed condyle fracture

Damage to the condyle is often accompanied by damage to other elements of the limb:

Small and large tibia;
Knee ligaments;
Meniscus.

Condyle fractures occur when several bone elements are suddenly compressed or displaced. They are divided into complete and incomplete. The first are accompanied by cracks, crushing and indentation of the cartilage.

If the injury is complete, all the connecting elements are torn off and cause damage to the tibia, causing excessive bleeding.

Diagnosis is carried out using an x-ray of the knee joint, which is performed in 2 projections. In 99% of cases, x-rays determine the exact diagnosis and type of damage.

If the results of the X-ray examination are ambiguous, then a CT scan of the knee joint is additionally prescribed. Suspicion of rupture or damage to the connecting elements (ligaments or meniscus) requires an MRI.

The split is accompanied by deformation of blood vessels and compression of the nerves. If complications are suspected, an additional consultation with a surgeon or neurosurgeon is prescribed.

Treatment occurs by applying a plaster cast. Duration of wearing – 4 – 8 weeks. The process of complete recovery after damage takes 20–30 weeks.

Lateral condyle fracture

Occurs when falling on a straight leg from the height of a car. Accompanied by the formation of a fragment, often with a displacement of almost 5 mm. There is a possibility of complications in the form of chondromalacia or osteochondritis dissecans.

Chondromalacia is a process of deformation of cartilage tissue, which leads to its complete damage. Osteochondritis dissecans is the separation of cartilage tissue from the bone element.

Head fracture

A common injury among professional athletes. A depressed fracture of the head is accompanied by a collision of bone and cartilage elements, and fragments are formed.

The line of injury affects the head and adjacent sections of the femur, with the neck suffering the most. The combined type of injury is considered complex, due to deterioration of the blood supply to the head itself. The treatment is long and requires maximum attention.

A depressed split of the head is accompanied by dislocation. If the hip is at rest, then a posterior dislocation is likely, in which the round ligament is torn off or a fragment breaks off from the edge of the acetabulum. Direct impacts to the head area lead to anterior injuries, splits or dislocations.

Treatment consists of taking medications. To speed up recovery, you need to eat a diet rich in vitamin D and fiber. Rehabilitation takes from 28 to 35 weeks.

Impression fracture of the internal condyle

Occurs as a result of a blow to the outer part of the shin, a strong abduction outward, or a fall with a dislocation of the knee area. The patient immediately feels a sharp pain, within 10 minutes the knee swells and hematomas occur. Accompanied by internal bleeding.

First aid is provided in the form of immobilization of the injured limb using a splint.

Upon arrival at the hospital, the injured area is palpated to determine the axis of the X-ray projection. The patient is sent for an x-ray, based on the results of which treatment is prescribed.

Species and types

The medical complex of surgical or therapeutic procedures is selected by the doctor depending on the type and type of damage.

Any part of the bone tissue of the hip can be injured, which forces fractures to be classified according to the following types:

Distal - in the lower part of the thigh;
Diaphyseal – the main body of the bone;
Proximal - damage to the upper part of the bone.

By type of fracture:

Open – with ruptures of surrounding soft tissues and ligaments;
Closed, without displacement of bone fragments.

Open fractures are the most dangerous, accompanied by a painful shock state. Individual bone fragments can severely damage nearby muscles, nerve endings or blood vessels, causing unbearable pain and bleeding. without displacement are not always recognized on time, but carry visual changes in the hip joint and limb.

More about varieties

The tubular bone of the femur is the largest anatomical segment of the lower extremities. It consists of the main body, head and neck, located in the upper part.

Fractures in the lower thigh

Distal fractures occur less frequently than others. They happen during a strong fall to the knees or direct blows to them, which leads to the breaking off of one or 2 bone fragments. The treatment is therapeutic, requiring the installation and fixation of fragments for up to six weeks.

Diaphyseal lesions

This type of injury is characterized by severe, acute pain and loss of the ability to move independently.

They are divided into:

Transverse;
Spiral;
Splintered;
No splinters;
Offset relative to the axis of the bone;
No offset.

Upper thigh injuries

The most common, complex and dangerous are proximal bone injuries, requiring long-term therapeutic or surgical treatment. The recovery period for a certain type of injury can be very prolonged, which adversely affects the health of older people.

The localization of the injury may be in:

Head;
Sheike;
Vertele.

According to the nature of the fracture, femoral neck injuries are:

Lateral – (with a lateral fracture);
Medial – (with a median fault line);
With offset;
No offset.

Fractures with head displacement are characterized by fragments entering the bone or placing the head down inward/upward outward.

Signs of a fracture

Symptoms of damage to the hip bone are as follows:

Inability of the patient to move independently.
Spontaneous inversion of the limb outward.
Shortening the injured leg.
Sharp or aching pain in the groin area and hip joint.
Severe swelling and swelling of the leg, bruising.
Increased pain when pressing on the injury site.

You can't ignore the signs! But, depending on the type of injury, they will not be clearly expressed, and the patient may not feel pain and move independently, leaning on the injured leg. Failure to see a doctor in a timely manner can result in loss of ability to work and even death.

Faults with displacement

In the event of a fall, collision or direct blow, a bone fracture occurs with displacement of fragments in any direction.

Signs of injury:

Acute pain, painful shock;
Swelling of the leg with obvious bruising;
Shortening of a limb;
Bleeding.

Surgical treatment allows you to quickly restore bone tissue, without the risk of improper fusion. If surgery is contraindicated, the patient is prescribed skeletal traction. In total, conservative treatment lasts about 12 months with the patient being fixed in a statistical position.

Proximal injuries

The inside of the joint or the surrounding bony area is damaged, causing injury to the trochanters (extra-articular fractures). Signs of damage;

Moderate, aching pain in the groin and hip area, which intensifies with active movements, is characteristic of intra-articular fractures;
Acute pain and painful shock are;
The leg turns in the other direction;
Severe swelling of soft tissues;
Inability to lift and straighten a limb in a supine position;
Swelling, bruising.

A fracture in the neck area can be completely healed only by surgery.

Distal fractures

Direct blows to the knee joints lead to a fracture of the condyle, characterized by the following signs;

Intense pain in the knee and hip area;
Immobilization of a limb;
Swelling of the knee;
Turning the shin outward.

Treatment consists of a cast or surgery if the crushed bone cannot be aligned. After 4-5 months, patients’ ability to work is restored.

Proper treatment and subsequent rehabilitation aimed at speeding up recovery are of great importance for fractures. Proper rest, avoiding physical activity and performing therapeutic exercises will allow the patient to quickly regain lost mobility and joy of life.

Features of anatomy

The femur is one of the large bones of the body. It is located between the pelvis and tibia. Forms 2 joints - hip and knee.

In the area of the hip joint, the bone has 2 necks - anatomical and surgical. The end of the bone has 2 trochanters, which are attached to the acetabulum of the pelvic bone.

Effective methods

Injuries should only be treated in hospitals. All fractures are treated by surgical comparison of the fragments.

Treatment of a fracture in old age is most difficult to tolerate, but it is not possible to properly heal the bone using a conservative method. in older people, metal osteosynthesis is required - a metal rod is placed into the bone at the fracture site to connect the fragments.

The leg is fixed in one position for a long time until a full-fledged bone callus is formed.

In case of fractures of the diaphysis, the fragments are connected by an extraosseous method - metal plates are applied to the surface of the bone, secured with bolts. With this method, bone fusion occurs faster, but a certain period of immobilization is still required.

In addition to surgery, patients require medication support. Drugs are prescribed to improve microcirculation in the area of injury - chimes, pentoxifylline.

Painkillers and anti-inflammatory drugs are needed. Calcium supplements are prescribed for long-term use.

Recovery and rehabilitation program

After the main treatment, a course of rehabilitation treatment is required.

Recovery time and consequences depend on rehabilitation measures:

Physical therapy techniques;
Firming massage;
Water aerobics;
Exercises on a gymnastic ball and swimming in the pool are useful.

Causes

Often the hip is broken as a result of a car accident, when it collides with a car bumper.

In the elderly, a common cause of injury is a fall, especially in icy winter conditions.

When falling from a height, a combined fracture of the femur and pelvis in the joint area usually occurs.

Symptoms

Fractures of such a large bone as the femur are quite easily identified upon examination. It is more difficult to determine a fracture in the proximal part, in the femoral neck.

To confirm the diagnosis, the radiographic method is used. It allows you to accurately determine the location of the fracture, assess the degree of damage to adjacent tissues, and detect loose fragments. Often no other diagnostic methods are required.

First aid

This is a serious injury that can even be fatal. Medical assistance should be provided at the scene of the incident.

If there is visible bleeding from damaged large vessels, a hemostatic tourniquet should be applied. The tourniquet should not be applied for more than 2 hours to prevent tissue necrosis.

Immobilize the broken leg to prevent further displacement of the bone fragments. To do this, the entire leg is covered from the foot to the lower back and the patient is transported on a stretcher in a lying position.

During transportation, painkillers are administered and, if necessary, infusion therapy is performed to restore the volume of lost blood.

Risk factors

There are very common causes of weakening:

Homocysteine (a toxic “natural” amino acid that has been linked to heart disease).
Other disorders of bone metabolism, Paget's disease, osteomalacia, osteoporosis and osteopsatirosis. Impaired bone metabolism can cause a stress fracture in the upper thigh.
In rare cases, a hip fracture will be caused by benign or malignant bone tumors.
Cancer metastases that form in the proximal femur can weaken the bone tissue and cause a pathological fracture of the femur.
In rare cases, bone infections can lead to hip fractures.

Diagnostics

The final diagnosis can be made after X-ray examination of the injured hip using anterior and posterior projections.

In cases where the hip fracture is not clearly visible on the x-ray, an MRI should be done. If an MRI is not available or the patient cannot be placed in the scanner, a CT scan can be performed as an alternative.

An MRI is more likely to detect a radiographically undetected fracture than a CT scan. Another research option can be bone scintigraphy.

Due to metabolic changes in older people, there will be significant obstacles such as decreased sensitivity, early false negative results, and unclear results.

Since the patient requires surgery, a complete preoperative general examination should be performed, which includes blood tests, ECG and chest x-ray.

Complications after a fracture

Fractures in the femoral neck are considered the most difficult. Here the bone heals slowly and incompletely due to poor blood supply. The bone fragments are fixed together by overgrown fibrous tissue. This is how a “false joint” is formed instead of a full callus.

The victim's osteoporosis rapidly progresses, bone tissue becomes loose and fragile as a result of metabolic disorders, and its density decreases. The curvature of the axis of the lower limb is visually noticeable.

A dangerous complication is aseptic necrosis of the femoral head. Parts of the bone marrow die due to lack of proper blood circulation and osteoporosis. The complication progresses slowly, over 6-12 months or several years.

External manifestations:

Impaired movement in the hip joint;
Reduced volume of rotation (rotational and circular movements);
Limitation of leg abduction;
Decreased amplitude during flexion-extension;
Shortening of the limb;
Forced position;
Atrophy of the femoral and gluteal muscles, an outwardly noticeable decrease in thigh girth.

After 1.5-2 years, the function of movement and support is significantly impaired. Deformation of the hip joint (coxarthrosis) is detected.

A common complication is contracture. This is a persistent restriction of movement in the joints of the injured leg. Support on the limb is impaired, walking becomes difficult. They are more common with diaphyseal (bone body) fractures. The injury is always severe, accompanied by massive bleeding, muscle tissue ruptures, and painful shock. During treatment, the leg is immobilized at the knee and hip joints for up to 8 months. This circumstance helps the formation of contractures.

Distal femoral fractures (condylar, near the knee joint) are rarely accompanied by complications. This is due to the accessibility of the injury site for full treatment and the absence of difficulties with rehabilitation. The exception would be injuries in elderly patients.

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This type of injury to the tibia refers to intra-articular fractures. In this case, both condyles (U- or T-shaped) or only one can be broken.

If, during a fall, greater pressure was applied to the outer surface of the leg, a fracture of the lateral condyle is diagnosed (the fibula is often damaged), if on the inner surface, a fracture of the medial condyle is diagnosed.

Compression fracture

This term refers to damage to bone tissue caused by compression under significant axial load. As a result of this impact, the articular platforms of the tibia and femur are brought closer together, and the condyles protruding from the sides and upwards are broken off. In this case, they can move downwards (displaced fracture) or remain in place, and the formation of fragments is also likely. Characteristic features:

Pain that sharply increases when trying to move the leg and palpation.
Pathological mobility of the injured knee joint. If the lateral condyle is broken, the tibia deviates outward, and if the medial condyle is damaged, it deviates inward. With a bilateral fracture, mobility is observed in both directions.
Limitation of movement - it is almost impossible to control the limb (bend, lift), as well as lean on it.
Hemarthrosis is a characteristic symptom of intra-articular fractures associated with rupture of blood vessels and filling of the joint cavity with blood. Externally it manifests itself as swelling of the knee.

The listed signs are quite sufficient to make a diagnosis. It is finally confirmed by an x-ray in two projections, which also makes it possible to determine the presence of displacement and other complications.

Impression fracture

This definition is essentially similar to the previous one, translated as “indentation.” The term was coined in the early 2000s and is now used to replace the word "compression" for joint fractures, as it characterizes the injury more accurately, since the articular surfaces are pressed into each other under significant vertical pressure.

Symptoms of damage

The intensity of pain does not always correspond to the degree of damage. Local pain is of great diagnostic importance.

It is determined by pressing with one finger. Hemarthrosis can reach large sizes and lead to a sharp expansion of the knee joint and poor circulation.

In such cases, it is necessary to urgently perform a puncture to remove the blood. Early active movements in the joint contribute to faster blood resorption.

A characteristic sign of condylar fractures is a typical deformity of the genu varum or genu valgum, which is explained by the displacement of fragments, as well as lateral mobility in the joint area.

Active movements are sharply limited and painful. Radiographs make it possible to clarify the nature of the fracture and the degree of displacement of the fragments.

The muscular system of the leg connects two large bones - the femur and the tibia. The condyles are ball-shaped projections located at the bottom of the femur.

The role of the condyles in the motor function of the leg is great. With the help of the condyles, flexion and extension of the joint occurs, and it is also possible to rotate the tibia bone outward and inward.

A fracture of the tibial condyle has the following symptoms:

Significant pain in the knee area, completely blocking leg movement. When pressing on the knee, the pain intensifies significantly.
Significant enlargement of the knee joint.
In some cases, there is a clear deformation and deviation of the tibia to the side.

If a person has a fracture of the tibial condyles, this can be determined by the presence of a fairly large number of different symptoms. These include:

Hemarthrosis
Painful sensations
Joint dysfunction
A very typical deformity seen in the genu varum or genu valgum
Presence of lateral movements in the knee joint

It must be emphasized that the intensity of the pain that appears does not always correspond to the degree of damage received. It is very important in the process of establishing a diagnosis to establish local

In this case, a sharp expansion of the knee joint will be observed, and blood circulation in it will be impaired. If such a symptom is observed, then specialists strive to urgently perform a puncture.

How to determine a fracture

It is almost impossible to find a position for the leg so that pain is not felt, and any change in position entails sharp, acute pain.

It must be emphasized that the intensity of the pain that appears does not always correspond to the degree of damage received. It is very important in the process of establishing a diagnosis to establish local

soreness. This can be done by pressing on the damaged area with one finger.

If you feel pain, you should immediately contact a specialist. When a fracture occurs, hemarthrosis is observed, which can reach significant sizes.

In this case, a sharp expansion of the knee joint will be observed, and blood circulation in it will be impaired. If such a symptom is observed, then specialists strive to urgently perform a puncture.

This is necessary in order to remove blood from the tissues.

There is another symptom of determining a fracture - this is a slight tapping of the fingers along the axis of the lower leg, which should cause pain in the sore knee. In general, movement in a sore knee is impossible, as it is accompanied by sharp pain. It is almost impossible to find a position for the leg so that pain is not felt, and any change in position entails sharp, acute pain.

In order to clearly make a diagnosis, it is necessary to take an x-ray of the knee joint, in two projections. This procedure will not only allow you to accurately establish the diagnosis, but will also show the nature of the resulting fracture, and in the case of a displaced fracture, it will show the degree of displacement of the fragments.

Fracture treatment

The basis of treatment includes the following principles: 1) early, and if possible, anatomical reduction of fragments to restore congruence of the articular surfaces; 2) reliable fixation of fragments before the onset of fracture consolidation; 3) the appointment of early active movements in the damaged joint; 4) late loading of the limb. Treatment of fractures of the tibial condyles should be differentiated. If there is a marginal fracture without displacement, a crack or an incomplete fracture, the limb is immobilized with a posterior plaster splint from the fingers to the upper third of the thigh for 3-4 weeks. Bed rest is indicated for 3-4 days. The patient can then walk with crutches. During the day, the splint is removed for the duration of active movements in the knee joint. Gradually increase the number of such exercises throughout the day.
In stationary conditions, the technique of adhesive or skeletal traction and the technique of simultaneous manual reduction with subsequent fixation using constant traction are used.

The basis of treatment includes the following principles:

early and, if possible, anatomical reduction of fragments to restore congruence of the articular surfaces;
reliable fixation of fragments before the onset of fracture consolidation;
prescribing early active movements in the damaged joint;

Treatment of fractures of the tibial condyles should be differentiated.

If there is a marginal fracture without displacement, a crack or an incomplete fracture, the limb is immobilized with a posterior plaster splint from the fingers to the upper third of the thigh for 3-4 weeks.

Bed rest is indicated for 3-4 days. The patient can then walk with crutches.

During the day, the splint is removed for the duration of active movements in the knee joint. Gradually increase the number of such exercises throughout the day.

In stationary conditions, the technique of adhesive or skeletal traction and the technique of simultaneous manual reduction with subsequent fixation using constant traction are used.

A fracture of the tibial condyles is a fairly serious injury that requires mandatory hospitalization after first aid. Complete healing and restoration of the condyles occurs only 5-6 months after the injury.

Treatment of a condylar fracture depends on the presence of displacement. For non-displaced fractures, a puncture is performed to remove blood and fluid. Next, for the purpose of fixation, a cast is applied to the entire leg from the buttocks to the toes.

When diagnosing a displaced fracture, the traumatologist performs a reposition and eliminates the displacement, after which skeletal traction is applied for up to 6 weeks.

If there are many bone fragments, there is a need for surgical intervention, in which the bone fragments are fastened with screws, knitting needles, staples or steel plates.

Specialists use certain principles that form the basis for the treatment of this type of fracture:

To restore congruence of articular surfaces, early anatomical reduction should be used, if possible.
Mandatory reliable fixation of such fragments until the fracture heals
If necessary, early loads should be prescribed on the affected joint (this load will be movement)

So, for example, if there is a crack, or a fracture without displacement, or an incomplete fracture of the condyle, then the injured leg should be fixed with a plaster splint for three to four weeks.

The splint should be applied to almost the entire sore leg (from the toes to the upper third of the patient’s thigh). During this time - 3-4 weeks - the patient must maintain bed rest.

After this, you can walk with the help of crutches.

Quite often, in a hospital setting, either skeletal or adhesive traction techniques are used. In addition, a manual one-step reduction technique can be used, after which fixation must be applied and the leg placed in traction.

In Fig. 351 shows a typical compression fracture of the lateral condyle. The fracture line enters the joint in the area of the intercondylar eminence. The articular surface is smooth and unchanged. The condyle is wedged on the outer and posterior sides, causing the formation of deformation in the form of genu val - gum and limitation of extension. There is a comminuted wedged fracture of the neck of the fibula.

Manual reduction

Strong traction and full extension of the knee joint are used to correct the posterior herniation of the fragment. The lower leg must be adducted to correct the genu valgum.

After this, the limb is fixed on the table with traction. The surgeon must correct the departure of the condyle by applying compression with both hands on both sides of the condyle, or using the Skodder, Thomas or Behler devices (see Fig.

Apply a plaster cast without padding from the fingertips to the groin. Verification x-rays are taken through a plaster cast.

Surgical treatment is not indicated for fresh fractures

Lifting the broken condyle fragment and attaching it with a nail. There is no need to secure the fractured condyle to the tibia with nails, screws, or bushings. Repeated displacements can be prevented by a well-applied plaster cast from the fingertips to the groin. 2-3 weeks after the swelling subsides, the bandage should be removed.

Subsequent treatment

Active exercises of the quadriceps muscle, consisting of its rhythmic contraction and relaxation, are immediately prescribed. After a few days, the patient is already able to lift the limb in a plaster cast, overcoming the force of gravity and even a load suspended from the ankle joint.

Weight-bearing of the limb can be allowed after 5-6 weeks only if a new plaster cast is applied. After 10 weeks, the plaster cast is removed and an elastic bandage is applied to the lower leg and knee joint to prevent swelling.

Movement in the knee joint is restored with active exercises, supplemented, if necessary, with massage after a few months, but not with passive stretching. Reduction of a comminuted fracture is very difficult.

Some of the fragments are pressed into the tibial condyle and cannot be removed and reduced either by manual reduction or by subcutaneous insertion of staples or wires. Surgical reposition is possible, but lever lifting of depressed fragments and their mosaic assembly requires very high surgical skill and is usually impossible after 10-14 days.

There are also more serious objections to surgical reposition: the blood supply to the free fragments is disrupted, and after surgery it may stop altogether. Avascular necrosis with replacement of articular cartilage by fibrocartilage or fibrous tissue becomes inevitable.

Raising necrotic cartilage to the level of the joint and in contact with the articular surface of the femur is of questionable value for joint restoration. At the same time, if the soft tissue was not separated from the bone during surgical reduction, then the main marginal fragment retains a normal blood supply.

Probably the best treatment is to restore the correct position of the marginal fragment with its viable articular cartilage and leave the avascular fragments with necrotic cartilage embedded in the tibial condyle.

The central crater, from where the displacement of these fragments occurred, is filled with fibrous scar tissue and remnants of the outer meniscus. It maintains the function of the knee joint, surrounded by viable articular cartilage, which then bears the weight of the body.

Traction is carried out on the table, correcting valgus deformity. Reduction of the marginal fragment requires strong compression.

Loose bone fragments wedged into the angle between the marginal fragment and the tibial condyle must be crushed, which cannot be achieved by manual compression.

The Thomas apparatus slips off the bone, and it is necessary to use a special clamp with cheeks in the shape of the condyle (see Fig.

353). The correctness of the reduction is checked with an x-ray, after which a plaster cast is applied for a period of at least 10 weeks.

Immediately begin active exercises of the quadriceps muscle until movement in the knee joint is restored.

Surgical reduction

In some cases, the condyle is so crushed that manual reduction becomes impossible. Rice. 354 and 355 illustrate such a case.

Rice. 354. Comminuted fracture of the lateral condyle of the tibia with rupture of the external and cruciate ligaments. The articular surface is damaged so badly that the fragments are rotated 180°. In such cases, surgical reduction is necessary.

Rice. 355. Despite osteoarthritis due to avascular necrosis of separated fragments, the function was preserved and the painful symptoms were negligible. The patient continued to work in agriculture 10 years after the injury.

The marginal fragment is relatively small, and the rest of the condyle is riddled with grooves. Some fragments are inverted and wedged between the front surface of the thigh and the tibia, others are pressed into the tibia.

Without surgical intervention, in such a case one can expect fibrous ankylosis of the joint, but even with such a fracture one should strive to avoid arthrodesis. Complete immobility in the knee joint is more important than in any other joint of the lower limb.

If the possibility of arthroplasty surgery for complete ankylosis of the knee joint is not excluded, then the problem of treating a crushed condyle fracture cannot be considered insoluble. The joint is opened from the outside, the meniscus is removed and the fragments are placed in their normal position.

Internal fixation of fragments is not required. Immobilization lasts 3 months.

Exercises for the quadriceps muscle are prescribed. They should be performed every hour for 5 minutes throughout the day.

Despite avascular necrosis and degenerative arthritis, restoring muscle strength protects the joint from sprains and twisting.

It is necessary to immediately clarify that the treatment of a condylar fracture

tibia is carried out in a hospital setting. If the patient has a displaced fracture, then a puncture of the joint is necessary to remove the blood accumulated in it.

As practice shows, almost always with any such damage, droplets of fat are found in the liquid that is taken during the puncture process.

After the blood has been removed, it is necessary to securely fix the limb with a special plaster cast, which should cover the leg from the gluteal fold to the toes. It is very important that the leg is at rest for a certain time.

But in any case, an individual approach should be taken to the treatment of a fracture of the tibial condyles. This means that treatment will be prescribed depending on the type of fracture and its severity.

So, for example, if there is a crack, or a fracture without displacement, or an incomplete fracture of the condyle, then the injured leg should be fixed with a plaster splint for three to four weeks. The splint should be applied to almost the entire sore leg (from the toes to the upper third of the patient’s thigh). During this time - 3-4 weeks - the patient must maintain bed rest. After this, you can walk with the help of crutches.

Quite often, in a hospital setting, either skeletal or adhesive traction techniques are used. In addition, a manual one-step reduction technique can be used, after which fixation must be applied and the leg placed in traction.

Correctly provided first aid for a condyle fracture is the initial stage of treatment, affecting the speed of healing and restoration of the joint. The victim should be immediately taken to a medical facility, trying not to disturb the injured limb and applying cold to the joint, or call an ambulance.

At the initial stage, treatment is carried out in a hospital, where, after examination and x-rays, a joint puncture is necessarily performed. This manipulation is needed to remove blood accumulated in the cavity. Further actions of the orthopedic surgeon depend on the type and severity of the injury:

A fracture without any significant damage to the ligamentous apparatus and displacement of fragments is treated by applying a pressure bandage to the knee after aspiration of the hemarthrosis. Then the leg is fixed in an elevated position for two days, and ice is applied to the joint.
Moderate injury requires longer immobilization. After the puncture, closed reposition of the displaced condyles is performed, and a plaster cast is applied from the foot to the thigh for 3-4 weeks.
In the presence of displacement, multiple fragments, ligament and meniscal tears, open reduction (surgical operation) is performed. Subsequently, skeletal traction is prescribed and a plaster cast is applied.

It is important! Three conditions for successful treatment of condylar fractures: restoration of the articular surface, movement in the joint area (prevention of contracture) and complete elimination of axial load. If a cast is not applied, you need to bend and straighten your leg from the first days of treatment, but you cannot lean on it for about a month.

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Then, it's OK! Everything is fine - for sure, if payment is made upon receipt. Thanks a lot!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandma doesn’t trust pills, the poor thing has been suffering from pain for many years...

Andrey A week ago

No matter what folk remedies I tried, nothing helped, it only got worse...

Ekaterina A week ago

I tried drinking a decoction of bay leaves, it didn’t do any good, I just ruined my stomach!! I no longer believe in these folk methods - complete nonsense!!

Maria 5 days ago

I recently watched a program on Channel One, it was also about this Federal program to combat joint diseases talked. It is also headed by some famous Chinese professor. They say that they have found a way to permanently cure joints and back, and the state fully finances the treatment for each patient

In relation to the knees there are:

intra-articular impression fractures, when the joint surface is damaged;
extra-articular.

Sharp debris injures neighboring tissues, cutting nerve and muscle fibers, arteries and veins. If there is a violation of the integrity of the skin, then they speak of an open fracture.

Urgent transportation of the victim to the nearest medical center is necessary. It is not advisable to move the patient until the ambulance arrives. You should distract from the pain syndrome by talking and make sure that the person does not lose consciousness.

In case of an open fracture, the first step is to stop the bleeding and apply an antibacterial bandage. It is acceptable to give analgesics to prevent painful shock.

It is better to entrust fixation of the limb to professional paramedics. There are several ways to do this:

Dieteriks tire;
inflatable devices;
improvised materials;
tying the sore leg to the healthy one.

When providing first aid, it is important not to disrupt the integrity of blood vessels and nerve fibers. The former threaten significant blood loss, while the latter take a long time to recover, if at all possible.

Diagnostics

The main method for determining the presence of a fracture of the femoral condyle remains radiographic examination in various projections:

anteroposterior projection;
side;
oblique.

When X-rays do not provide complete information, a computed tomography scan is performed.

The basic rule of first aid for a fracture is to immobilize the injured limb and call emergency medical help. Under no circumstances should you transport a person to the hospital yourself. Incorrect position during transport and ambulation can lead to displacement of the condylar fragment.

If the pain becomes unbearable, you can give an anesthetic drug, for example, Analgin.

Important! Before the doctor arrives, it is necessary to talk with the person who was injured, thereby distracting him from the pain.

You cannot set the bone yourself! Such actions will only worsen the damage.

Conservative treatment

Conservative treatment involves first removing the blood that has accumulated in the knee joint. To do this, use a special syringe for puncture. Next, the joint is anesthetized by injecting a solution of novocaine. In this case, the needle is not removed from the knee; only the syringe itself is changed.

After these manipulations, a plaster cast with a window is applied to the knee, through which a second puncture is made if necessary. The patient will spend 4 to 6 weeks in a cast, then a new x-ray will be taken to monitor bone healing and prescribe rehabilitation procedures.

Movement is allowed with the help of crutches. Weight-bearing on the injured limb is possible after 3 months or later. Restoration of performance occurs after 4-5 months.

Constant traction

To treat a fracture of the femoral condyle without displacement, the traction method is often used:

The injured leg is slightly bent at the knee and placed on a Beler splint.
A knitting needle is passed through the heel bone and a load weighing from 4 to 6 kg is hung on it.
After 3-4 days, flannel bands are attached, directed in opposite directions: one bandage passes through the shin, the other through the knee. Weights weighing about 3 kg are attached to them; this is usually enough to restore and maintain the integrity of the hip bone.

The patient remains in this position for 1 to 1.5 months. He is then put in a cast for several weeks. The load is introduced gradually.

Surgical treatment

Surgery is required for a displaced condyle fracture. It is performed under general anesthesia 3-7 days after the injury. The consequences of the fracture are removed through the incision:

released blood;
liquid;
small bone fragments.

The broken part of the condyle is replaced and secured to the femur with a long screw. It must enter the condyle from the opposite side. If two condyles are fractured, they are secured with two screws.

Fact! If the broken part of the condyle is large, I can also fix it with 2 screws.

When two condyles of one bone are fractured, the method of fixing them with screws and a plate is also used. In this case, the screws pass first through the metal plate, then through the bone tissue.

Sutures and a plaster cast are applied for up to 1.5 months. Restoration of all functions of the knee joint will occur no earlier than after 4 months.

Removal of metal elements occurs after 1 year, after taking an x-ray.

If an impression fracture occurs, in which the spongy tissue of the condyle is crushed, transosseous osteosynthesis is performed, since the desired effect is not achieved when fastening with screws.

The first sign of injury is acute pain. Then swelling appears in the knee joint. Subsequently, the development of deformity of the valgus or varus type is possible.

When diagnosing a fracture of the tibial condyles, the radiographic method is used. The image is taken in two projections to clarify the location and type of injury. The radiographic method allows us to judge the type of fracture and the condition of the ligamentous apparatus.

Damage to the ligaments is characterized by widening of the joint space, this is clearly visible in the picture.

If the x-ray does not give a complete picture, the doctor suspects damage to adjacent tissues, and a CT scan is performed. This method is more reliable, however, such a study is performed only when indicated. If the ligamentous apparatus is damaged, an MRI must be done to clarify the diagnosis.

This method allows you to see soft tissue structures and assess their condition.

In case of combined damage, damage to arteries and nerves, consultation with a vascular surgeon is required.

Damaged condyles need to be realigned. The operation is performed in the traumatology department. If there is a complete avulsion with damage to the structures, it is performed under general anesthesia, if the fracture is incomplete, under local anesthesia. For local anesthesia, a solution of novocaine is used, which is injected into the knee joint.

After this, the traumatologist determines the tactics and type of operation. In case of slight displacement of the condyles, cracks, or marginal fractures, a cast is applied; it will have to be worn for about 8 weeks. This period depends on the type of damage and the age of the patient.

Children's bones heal much faster than older people's.

In case of a complete fracture, skeletal traction is performed. This is one way to treat complex injuries using a special structure that helps hold broken bone fragments in one position.

In case of combined injuries, a complex operation is performed: the fragments are fixed with screws or plates. If the surrounding tissues are severely damaged, it is dangerous to install plates or screws; in this case, an Ilizarov apparatus is installed, which fixes the limb from the outside until the soft tissues are restored.

If bone fragments touch the vessels, they are sutured to restore blood circulation.

Depending on the complexity of the injury, the operation is performed:

by arthrotomy. The doctor opens the knee joint to remove fragments and suture vessels or ligaments;
by arthroscopy. Modern minimally invasive surgery through small punctures.

In childhood, when the tibial condyles are fractured, limb deformities may develop a year after the injury. This is the result of curvature of the diaphyseal part of the tibia. To prevent such complications, the help of a qualified specialist is necessary.

With fractures of the tibial condyles, there are a sufficient number of signs to make a correct diagnosis: pain, hemarthrosis, typical deformity of the genu valgum or genu varum, lateral movements in the knee joint, dysfunction of the joint. The intensity of pain does not always correspond to the degree of damage. Local pain is of great diagnostic importance. It is determined by pressing with one finger. Hemarthrosis can reach large sizes and lead to a sharp expansion of the knee joint and poor circulation. In such cases, it is necessary to urgently perform a puncture to remove the blood. Early active movements in the joint contribute to faster resorption of blood. A characteristic sign of condylar fractures is the typical deformation of the genu varum or genu valgum, which is explained by the displacement of fragments, as well as lateral mobility in the joint area. Active movements are sharply limited and painful. Radiographs make it possible to clarify the nature of the fracture and the degree of displacement of the fragments. The basis of treatment is the following principles: 1) early, and if possible, anatomical reduction of fragments to restore the congruence of the articular surfaces; 2) reliable fixation of fragments before the onset of consolidation of the fracture; 3) the appointment of early active movements in the damaged joint; 4) late loading of the limb. Treatment of fractures of the tibial condyles should be differentiated. If there is a marginal fracture without displacement, a crack or an incomplete fracture, the limb is immobilized with a posterior plaster splint from the fingers to the upper third of the thigh for 3-4 weeks. Bed rest is indicated for 3-4 days. The patient can then walk with crutches. During the day, the splint is removed for the duration of active movements in the knee joint. Gradually increase the number of such exercises throughout the day.
In stationary conditions, the technique of adhesive or skeletal traction and the technique of simultaneous manual reduction with subsequent fixation using constant traction are used.

To fully understand the clinical picture, the doctor asks about the details of the accident. The victim must be informed:

circumstances of the emergency (how and when it happened, what caused the fracture of both condyles or one of them);
about the presence of underlying diseases, especially those related to the cardiovascular system and musculoskeletal system;
about diabetes mellitus, if indicated in the patient’s medical record. The disease significantly complicates regenerative processes and limits the choice of acceptable medications.

During a visual examination, the traumatologist:

excludes other damage to bone tissue or the presence of broken blood vessels (internal hemorrhage);
examines the condition of the skin for the presence of breaks, indicating an open fracture without or with displacement;
checks the condition of nerve endings and their ability to conduct impulses.

Hardware research completes the collection of information and helps to see the state of the femoral condyles hidden from human eyes:

X-ray. It is able to show a clear picture, helps to see the location of the fracture, possible complications, and determine the type of injury. In this case, the radiologist pays attention to the hip and ankle joints: they could also be deformed.
An MRI can help “look inside” the knee if a specialist suspects a meniscus fracture or rupture of the cruciate and collateral ligaments due to a fracture of the lateral femoral condyle.
CT is the clearest and most modern way to see the true state of affairs. In the image, the doctor sees not only the fracture itself, but also the separated fragments of bone tissue.
Other tests and examinations. Required when injuries to other organs are suspected, as well as for a more complete understanding of the patient’s condition. These include: ultrasound examination, blood test for hemoglobin and leukocyte levels, MRI of the brain, peritoneum, and chest.

Two main ways:

conservative;
operating.

The choice is made by the attending physician based on the presence of:

displacement of fragments;
background diseases (heart disease, diabetes, vascular problems).

At a young age, people usually want not just to recover, but to achieve complete restoration of the limb, which is often impossible without surgery.

In other cases, in the absence of complications, conservative methods are sufficient, which do not always achieve an ideal result in terms of aligning the axis in the leg, but are safer and do not require long-term rehabilitation, accompanied by active drug treatment.

Conservative way

The main principle is to achieve maximum immobilization of the hip and knee. For this purpose:

splints;
circular plaster cast;
plastic plaster.

Advantages of the latter:

light in weight;
comfortable to wear.

Orthoses do not limit activity 100%, allowing small movements at a given amplitude. Braces are used less frequently, and the decision in this case is made only by a traumatologist or surgeon.

Regular x-rays show:

effectiveness of the chosen immobilization method;
speed of regenerative processes;
displacement of debris that occurred during the treatment period.

Primary callus appears only after a few weeks. Such “rest” is extremely harmful for the knee joint, the health of which directly depends on the presence of physical activity. If the period of immobilization is prolonged, adhesions may form and the available amplitude may decrease.

Often the separated fragments move along with muscle contraction, not only causing pain, but also making normal tissue fusion impossible. Since callus only forms on immobile bones, surgery is required to force the parts of the condyle together in a displaced manner.

Otherwise, the leg will not be able to bear the full load of the body due to the formation of false joints.

Advantages of the method:

complete restoration of bone from fragments;
elimination of displacement;
re-building the limb axis.

During skeletal traction, the fragments are held together:

screws;
pins;
plates.

In severe cases, an arthrotomy is required, where the surgeon opens up the damaged knee joint. The rest are limited to arthroscopy with the insertion of a special video camera into the cavity.

The choice of fastening is determined by the type and complexity of the fracture, as well as the capabilities of the particular operating room. If the condyle is damaged, normal osteosynthesis is extremely difficult to obtain. The operation is accompanied by constant X-ray monitoring.

Modern materials and devices for fixation do not require large incisions, limiting themselves to a few small ones, which affects:

healing speed;
protection against infections;
cosmetic result.

After an injury, severe swelling is observed in the area of the knee joint. It is often accompanied by hemorrhage into the cavity of the affected area. If the fracture is serious and displaced, then a valgus or varus deformity of the knee joint is recorded.

When palpating the tibial condyle, a person feels acute pain. It is also observed during movement and the application of axial load.

Fractures of the tibial condyles must be differentiated from injuries to the menisci, ligaments, joints and other parts. In this case, the treatment regimen is somewhat different, so it is important to make a correct diagnosis.

During diagnosis, an important role is given to the radiograph. It is this that allows you to obtain an accurate diagnosis and become familiar with the nature of the damage.

At the time of injury, a person notices the following symptoms:

sharp and severe pain in the affected area;
instant swelling;
hemorrhage;
hematoma.

Often the clinical picture is complemented by a pronounced displacement. The victim's movements are limited, moreover, they cause a lot of discomfort.

In this case, pathological joint mobility may be observed. Gently pressing on the fracture of the tibial condyle allows the specialist to palpate the most painful area.

During the examination, pronounced hemarthrosis is recorded, sometimes it contributes to the disruption of local circulation.

When you receive an injury, it is important to immediately begin diagnostic measures. This will allow you to quickly make a diagnosis and prescribe the optimal treatment regimen.

The main research method is radiography. Thanks to her, it is possible to obtain the most complete picture of the damage.

X-rays are taken in two projections, which allows you to fully examine the affected area. In many cases, x-rays will document the fracture.

If during the study the doctor received an ambiguous result, it is recommended to resort to additional diagnostic methods. This may be a computed tomography or magnetic resonance imaging scan. In case of complex damage to the tibial condyle, compression of the nerves and blood vessels is recorded. In this case, it is advisable to consult a neurosurgeon.

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

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 anterior-posterior direction. The condyles are covered by fibrocartilaginous menisci, which reduce the load on the articular surfaces transmitted through the proximal tibia during movement.

Etiology and classification

Diagnosis and symptoms of fractures of the tibial condyles

Meniscus tears and cruciate ligament sprains and tears also occur.

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

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

CT scanning may also be useful in preoperative planning. If arterial damage is suspected, arteriography is necessary.

The degree of damage to the menisci, as well as collateral and cruciate ligaments can be assessed using MRI.

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

Movements are allowed early. This is necessary to prevent stiffness and promote cartilage restoration.

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

Surgical treatment is indicated for a displaced injury, a fracture accompanied by depression of the articular surfaces of more than 4 mm, a fracture accompanied by valgus or varus instability of the knee joint, determined at maximum knee extension of more than 10 degrees.

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

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

In case of a split fracture without displacement and the possibilities of reposition limited by soft tissue damage, the fragments can be fixed with lag screws. Comminuted type V fractures, type VI fractures, and injuries involving severe soft tissue damage may require additional fixation with hybrid external ring devices.

This method of treatment is also indicated in the presence of severe concomitant diseases that are a contraindication to surgical treatment.

If the anterior cruciate ligament is torn centrally, reconstruction should be delayed until the fracture has healed.

Complications of injury

At the time of injury, sharp pain appears in the knee. The knee is enlarged in volume; with a fracture of the internal condyle, a varus deformity may be detected, and with a fracture of the external condyle, a valgus deformity can be detected.

Movement and support are severely limited. Pathological mobility is observed during lateral movements in the joint.

By applying gentle pressure on the condyles with one finger, you can usually clearly identify the area of maximum pain. There is pronounced hemarthrosis, which sometimes causes a sharp expansion of the joint and disturbances in local circulation.

The main method of instrumental diagnosis is radiography of the knee joint. X-rays are taken in two projections.

In the vast majority of cases, this will allow us to reliably establish not only the fact of the presence of fractures, but also the nature of the displacement of the fragments. If the X-ray results are ambiguous, the patient is referred to a CT scan of the knee joint.

If concomitant damage to soft tissue structures (ligaments or menisci) is suspected, an MRI of the knee joint is prescribed. Sometimes condyle fractures are accompanied by compression of nerves and blood vessels; if damage to the neurovascular bundle is suspected (vascular damage and nerve damage), consultations with a vascular surgeon and neurosurgeon are prescribed.

Treatment of this pathology is carried out in a trauma department. Upon admission, the traumatologist performs a puncture of the knee joint and injects novocaine into the joint to anesthetize the fracture.

Further tactics are determined taking into account the characteristics of the injury. For incomplete fractures, cracks and marginal fractures without displacement, a plaster cast is applied for 6-8 weeks.

Walking with crutches is prescribed and the patient is referred to UHF and exercise therapy. After stopping immobilization, it is recommended to continue using crutches and not lean on the limb for 3 months from the date of injury.

For displaced fractures, depending on the type of fracture, one-stage manual reduction followed by traction or traction without previous reposition is used. The presence of slight displacement allows the use of adhesive traction.

In case of a fracture of one condyle or both condyles with significant displacement, as well as in a fracture of one condyle with subluxation or dislocation of the other condyle, skeletal traction is applied.

Traction is usually maintained for 6 weeks, during which time exercise therapy is performed. Then the traction is removed, the patient is recommended to walk on crutches without putting weight on the leg.

A distinctive feature of intra-articular fractures is delayed healing, so light weight bearing on the leg is allowed only after 2 months, and full support after 4-6 months. .

Indications for surgical intervention are an unsuccessful attempt to reduce fragments, pronounced compression of fragments, entrapment of a fragment in the joint cavity, compression of blood vessels or nerves, and a fracture of the intercondylar eminence with displacement when closed reduction is unsuccessful.

For ordinary fresh injuries, an arthrotomy is performed. Fragments lying freely in the joint cavity are removed. Large fragments are set and fixed with a screw, nail, knitting needles or special L- and T-shaped support plates. For multi-fragmented injuries and open fractures, external osteosynthesis is performed using the Ilizarov apparatus.

For fresh fractures with significant compression, unresolved and old fractures, as well as secondary subsidence of the condyles due to premature load on the leg, osteoplastic surgery according to Sitenko is performed.

The joint is opened, an osteotomy is performed, the upper fragment of the condyle is raised so that its articular surface is located at the same level and in the same plane with the surface of the second condyle, and then a wedge made of autogenous or heterogeneous bone is inserted into the resulting gap.

The fragments are fastened with tightening screws and a plate.

After osteosynthesis, the wound is sutured in layers and drained. With stable fixation, immobilization in the postoperative period is not required.

The drainage is removed for 3-4 days, then physical therapy with passive movements is started to prevent the development of post-traumatic joint contracture. Thermal procedures are prescribed.

After the pain has reduced, they move on to active development of the joint. Light axial load on the limb with conventional osteosynthesis is allowed after 3-3.5 months, when performing bone grafting - after 3.5-4 months. Full support on the leg is possible after 4-4.5 months. .

The prognosis with adequate comparison of fragments, compliance with the doctor’s recommendations and treatment time is usually satisfactory. The lack of complete anatomical reduction, as well as premature axial load on the joint, can provoke subsidence of the fragment, which causes the formation of valgus or varus deformity of the limb with the subsequent development of progressive post-traumatic arthrosis.

Rehabilitation, prognosis for recovery

When to load a sore joint depends on the severity of the fracture. With the conservative method of treatment and with traction, minimal loads are allowed after a week.

After the plaster is removed, it is necessary to carry out rehabilitation measures:

Massage. Improves blood supply to the extremities, which has a beneficial effect on the healing of damaged tissues and bone healing.
Physiotherapy. Allows you to get rid of swelling and relieve pain.
Exercise therapy. Regular performance of a set of exercises selected by a physical therapy instructor will help avoid muscle atrophy and restore motor functions of the knee joint.

Rehabilitation period

Restorative procedures should be started as soon as the attending physician allows. Regular physical activity on the leg is important to restore normal function and promote healing.

Prescribed:

Exercise therapy: cyclic exercises for joints, gradually becoming more complex.
Physiotherapy. Relieves inflammation and pain, accelerates local metabolism and enhances tissue regeneration.
Massage. Conducted by a specialist. Accelerates blood, improves cellular respiration, promotes timely elimination of toxins.
Gymnastics. Adequate load will relieve physical inactivity and prevent muscles from atrophying during the rehabilitation period. Gradually, the affected leg begins to be trained equally with the healthy one. Everything happens under the supervision of a doctor.
SRM therapy. It is performed using a special apparatus without muscle tension. Can be used the very next day after surgery.

After healing, it is necessary to continue training in the absence of pain. These may include simple walking or exercise on an exercise bike.

Before starting self-care for the injured leg, the patient receives advice on the following issues:

how intense physical activity and exercise therapy can be;
how soon can you return to work, taking into account your profession;
Should you stop taking previously prescribed medications?
how existing diagnoses can affect the rehabilitation period and the quality of healing;
when ability to work is restored.

The doctor also schedules follow-up examinations for visual analysis and repeat x-rays.

Additionally, vitamin and mineral complexes with a high content of potassium and calcium are prescribed. But tablets are not enough to speed up regeneration. A properly selected diet will restore immunity and help the body cope with the consequences faster.

You should include in your daily diet:

cottage cheese;
eggs;
nuts;
liver;
fatty fish (mackerel);
vegetables and greens.

When such a severe injury occurs, all resources are devoted to healing the condyle. Taking good care of your own health will help reduce recovery time and prevent serious consequences.

Limb injuries are especially common in winter - due to icing, the number of unsuccessful falls increases sharply. Joint injuries are the most severe. Bringing a lot of inconvenience, they are difficult to cure and take a long time to heal.

A fracture of the tibial condyle, compression or impression (inside the joint) is one of the most common. It can happen when the victim falls with straightened limbs or under other circumstances.

Fracture of the condyles of the tibia - damage to the thickening at its end. This is where the ligaments and muscles attach. There are two of them - internal (medial) and external (lateral). The condyles are quite fragile because they are covered with cartilage. This tissue differs from bone elasticity; it is not so resistant to external influences.

A comminuted fracture of the tibial condyle is a consequence of its displacement. When a person falls, they are sharply compressed. A dense layer of metaphysis is pressed into the epiphyseal spongy composition. The epiphysis divides into a pair of parts, breaking the condyles.

You can determine which part is broken by external signs:

the tibia moved outward - a fracture of the internal condyle of the tibia occurred due to displacement;
The shin moved inward - the internal condyle was damaged.

Complete fractures are also identified when the condyle is separated. If the fracture is not completely complete, indentation or cracks are likely - but without separation. Also, a fracture of the fibula or tibia with an affected condyle can be with or without displacement.

Often such injuries are accompanied by accompanying troubles:

injury to the fibular bone;
ligamentous and meniscal tears, tears;
fractures of the elevation between the condyles.

Symptoms and diagnosis

Fractures of the tibial condyles have characteristic symptoms:

pain;
disorders of joint functioning;
hemoarthrosis;
specific deformation;
lateral movements of the knee joint.

Pain does not always depend on the severity of the injury. A displaced fracture of the lateral condyle of the tibia may not be felt. Therefore, the damaged area should be probed by a specialist. This is how the doctor determines the presence of pain in certain points. You can simply apply pressure on the knee joint yourself. If the sensations are unpleasant, it is better to visit a traumatologist.

Hemoarthrosis, sometimes reaching significant sizes, is also characteristic of such injuries. The fact is that the joint increases in volume, thereby disrupting blood circulation. In this case, the doctor sends the victim for a puncture, which involves getting rid of accumulated blood.

Suspicions of a fracture of the medial or lateral condyle of the tibia may also appear after tapping the axis of the tibia with the fingers. If the pain is severe, then they are most likely broken. It will be very painful every time you move the affected knee. It’s not easy to find a position in which it will be easier. Any change in the position of the leg leads to new pain attacks.

Treatment

A fracture of the condyles or intercondylar eminence of the tibia is treated, taking into account the specifics of the injury. First, the fragments are set - if there are any. Then they are fixed until total consolidation occurs. An ice bag is applied to the limb.

If there is a crack or incomplete fracture of the internal or external condyle of the tibia, plaster splints provide immobilization - from the upper third of the thigh to the fingers. It is placed for a month.

In the hospital, traction is done, either adhesive or skeletal, as well as simultaneous manual reduction, then fixed with constant traction. When a minor fracture of the tibia condyle occurs with concomitant displacement, they are pulled by the tibia using the glue method. A pair of repositioning side loops is used.

In case of a marginal fracture of the lateral condyle of the tibia, the lateral loop is installed so as to direct traction outward from the inside. This eliminates the typical deformity, and the displaced condyle is reduced and held in the correct position.

If a fracture causes severe displacement, subluxation or dislocation of one or both condyles, skeletal traction has to be performed. An ankle clamp is used for this.

To bring condyles that have moved to the sides closer to one another, the N.P. system apparatus is suitable. Novachenko or side loops. Sometimes you have to manually set the displaced fragments. Pain relief used:

on the spot;
into the spinal cord;
general.

If traction is used, in the absence of acute pain, you can move on to intense movements within a few days. Early activity helps to achieve better reduction of fragments and create congruence of joint surfaces.

Adhesive, as well as skeletal, traction is usually eliminated a month after installation. After the skeletal procedure, additional adhesive traction is placed for half a month. When the traction is completely removed, the victim can get to his feet without putting much strain on the injured leg. It will be possible to fully activate it no earlier than in another month.

Surgery

The operation must be performed if:

Reduction of the fragments did not help;
closed reduction with further traction did not help;
a fragment is pinched inside the joint;
there is a fracture between the condyles;
fragments are compressed brightly;
vessels and nerves were pinched.

Even skeletal traction, which usually provides the best comparison of fragments, does not always help. As a result, there are more indications for surgery, and doctors give this recommendation to victims more often.

If the lesions are fresh, an arthrotomy is performed. In this case, the smallest particles present in the joint are completely removed, and large ones are subjected to fixation:

cloves;
knitting needles;
screw;
special plates for support.

For open fractures or with multiple fragments, external osteosynthesis is performed using an Ilizarov apparatus. The Sitenko osteoplastic procedure is performed if:

old closed fracture of the internal or external condyle;
subsidence of the condyles is secondary, due to intense load on the injured leg;
fresh injury with high compression.

The joint is opened and then an osteotomy is performed. As a result, the upper part of the affected condyle rises to the height of the second condyle. The joint areas must be in a single plane. The resulting void is filled with a wedge. It is prepared in advance from bone - auto- or heterogeneous. The collected fragments are fixed with a plate and screws.

Then the wound is sutured and drained. After the operation, immobilization is carried out. The drainage is removed after three to five days.

It is necessary to perform exercise therapy based on passive exercises to prevent joint contracture. Thermal procedures are shown. When the pain subsides, you can work on the affected joint.

After conventional osteosynthesis, light axial loading is allowed three months later, after bone grafting - after four months. You will be able to fully rely on your limb in five months. The results of treatment will be positive if it is carried out correctly and the patient follows all the doctor’s recommendations.

Complications

Compression or non-compression fracture of the tibial condyle requires a competent approach to treatment and following the recommendations. Diagnosis of fractures and intervention by doctors is carried out as early as possible. Experienced doctors should deal with trauma.

Otherwise, serious consequences are possible:

long-term immobilization;
degenerative arthrosis;
angular deformities of the limb;
infection of the wound during surgery.