Fractures of the femoral condyles and tibia: causes, symptoms, diagnosis, treatment

Fractures of the femoral and tibia condyles are classified as intra-articular injuries of the knee joint.

ICD-10 code

• S82.1 Fracture of proximal tibia.
• S72.4. Fracture of lower end of femur.

What causes femoral and tibia condyle fractures?

The mechanism of injury is predominantly indirect. This is excessive deviation of the tibia or femur outward or inward, excessive load along the axis, and more often a combination of factors. Thus, with excessive abduction of the tibia, a fracture of the outer condyle of the femur or tibia may occur, with excessive adduction of the tibia, a fracture of the inner condyles of the same segments occurs.

Symptoms of a fracture of the femur and tibia condyles

I am concerned about pain in the knee joint, impaired joint function and the support capacity of the limb.

Classification of fractures of the femoral and tibia condyles

There are fractures of the outer and inner condyles of the femur and tibia, and fractures of both condyles. The latter can be V- and T-shaped.

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Diagnosis of fractures of the femoral and tibia condyles

Anamnesis

History of characteristic trauma.

Inspection and physical examination

During examination, varus or valgus deformity of the knee joint can be detected. It is enlarged in volume, the contours are smoothed. Palpation reveals pain at the site of injury, sometimes crepitus and the presence of effusion (hemarthrosis) in the knee joint, characterized by fluctuation and balloting of the patella. Positive symptom of axial load. Passive movements in the knee joint are painful and can be accompanied by crunching.

Laboratory and instrumental studies

Radiography in two projections clarifies the diagnosis.

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Treatment of fractures of the femoral and tibia condyles

Conservative treatment of fractures of the femoral and tibia condyles

In case of fractures without displacement of fragments, a puncture of the knee joint is performed, hemarthrosis is eliminated and 20 ml of 2% procaine solution is administered. A circular plaster cast is applied from the upper third of the thigh to the tips of the fingers on the limb extended at the knee joint to an angle of 5°. If one condyle of the femur or tibia is broken, fixation of the limb is performed with the addition of hypercorrection - deviation of the tibia outward with a broken internal condyle and vice versa, i.e. to the healthy side.

Fractures of one femoral or tibia condyle with displacement are treated conservatively. Hemarthrosis is eliminated. A 2% procaine solution (20 ml) is injected into the joint cavity and reposition is performed by maximally deviating the tibia to the side opposite the fractured condyle. Fingers are used to try to press the fragment to the parent bed. The manipulation is performed on an extended limb. The achieved position is fixed with a circular plaster cast from the inguinal fold to the tips of the fingers in a functionally advantageous position.

The period of permanent immobilization for fractures of one femoral condyle is 4-6 weeks. Then the splint is converted to a removable one and rehabilitation treatment begins, but weight-bearing on the leg is prohibited. After 8-10 weeks, immobilization is removed and after X-ray control, the patient is allowed to carefully step on the leg with crutches, gradually increasing the load. Free walking is possible no earlier than after 4-5 months. Working capacity is restored after 18-20 weeks.

The tactics for fractures of the tibia condyles are the same. The periods of permanent immobilization are 4-6 weeks, removable - 8 weeks. Work is permitted after 14-20 weeks.

In case of fractures of two condyles with displacement of fragments, alignment is achieved by traction along the axis of the limb and compression of the condyles from the sides by hands or special devices (vices). The limb is fixed with a circular bandage. If reposition is unsuccessful, skeletal traction is applied to the calcaneus with a load of 7-9 kg. X-ray control is performed after 1-2 days. During this period, alignment of fragments along the length occurs, but sometimes a displacement along the width remains. It is eliminated by lateral compression of fragments and, without stopping traction, a plaster tutor is applied from the upper third of the thigh to the foot. The limb is placed on a splint and skeletal traction is continued. It should be noted that traction, reposition, plaster immobilization are performed on the limb extended to an angle of 175°. The load is gradually reduced to 4-5 kg. Traction and permanent immobilization are eliminated after 8 weeks, then rehabilitation treatment is started. A removable splint is indicated for 8-10 weeks in case of a fracture of the femoral condyles, for 6 weeks - in case of a fracture of the tibia condyles. Working capacity is restored in patients with fractures of both femoral condyles or the tibia after 18-20 weeks.

Surgical treatment of fractures of the femoral and tibia condyles

Surgical treatment consists of the most accurate comparison of fragments and their tight fastening. This can be achieved in various ways. One of them is compression osteosynthesis, developed in our country by I.R. Voronovich and F.S. Yusupov. Its essence is that two spokes with stop pads are passed through the fragments that have diverged in width. The end of the spoke opposite the stop pad is fixed in a bracket. It is moved apart, creating compression of the bone fragments. Similar compression of fragments can be carried out in external fixation devices using additionally passed spokes with stops. The method is quite effective, but requires strict adherence to asepsis, since the spokes create a channel that communicates the joint cavity with the external environment through the fracture line.

Other types of rigid fixation of fragments involve connecting them with screws, bolts, plates and combinations of these devices.

Of all the modern fixators used to treat patients with femoral condyle fractures, the DCS design should be considered optimal. It stably holds the fragments together, which makes it possible to avoid external immobilization of the limb and to begin movements in the knee joint early.

Fractures of the tibia condyles are treated similarly to fractures of the femoral condyles. It should be recalled once again that these are intra-articular fractures, so it is necessary to strive for ideal alignment of the fragments. Unfortunately, even open reposition often presents significant difficulties, especially if it is not performed within the first 3-4 days after the injury.

Comparison of fragments is achieved by tensioning the collateral ligaments by deflecting the tibia inward and outward, using various elevators, wide osteotomes, etc. Control over reposition is performed by palpation from the side of the articular surface and by X-ray examination.

If the reposition is successful, the fragments should be fixed with 2-3 Kirschner wires and only then move on to the final method of osteosynthesis to avoid repeated displacement of the fragments during the manipulation.