Fractures of the condyles of the hip and lower leg: causes, symptoms, diagnosis, treatment

Fractures of the condyles of the femur and lower leg are referred to intraarticular injuries of the knee joint.

ICD-10 code

• S82.1. Fracture of the proximal part of the pubic bone.
• S72.4. Fracture of the lower end of the femur.

What causes a fracture in the condyles of the hip and lower leg?

The mechanism of injury is mostly indirect. This excess deviation of the tibia or femur from the outside or inside, excessive load along the axis, and more often a combination of factors. Thus, with excess tibial lead, a fracture of the external condyle of the thigh or shin may occur, with an excessive reduction of the tibia, a fracture of the inner condyles of the same segments occurs.

Symptoms of fracture of the condyles of the femur and lower leg

Disturb pain in the knee joint, a violation of the function of the joint and the ability to support the limb.

Classification of fractures of the condyles of the femur and lower leg

There are fractures of the external and internal condyles of the femur and lower leg, fractures of both condyles. The latter can be V- and T-shaped.

[1]

Diagnosis of fracture of the condyles of the femur and lower leg

Anamnesis

A characteristic trauma in the anamnesis.

Examination and physical examination

On examination, one can detect varus or valgus deformity of the knee joint. It is enlarged in volume, contours are smoothened. Palpation reveals pain in the place 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 the axial load. Passive movements in the knee joint are painful and can be accompanied by a crunch.

Laboratory and instrumental research

Radiography in two projections clarifies the diagnosis.

[2]

Treatment of fractures of the condyles of the femur and lower leg

Conservative treatment of fracture of the condyles of the femur and lower leg

In fractures without displacement of fragments, puncture of the knee joint is made, hemarthrosis is eliminated and 20 ml of a 2% solution of procaine are injected. Apply a circular gypsum dressing from the upper third of the thigh to the ends of the fingers on the limb, unbent at the knee joint, to the angle of 5 °. If one condyle of the femur or lower leg is broken, limb fixation is performed with the addition of hypercorrection - the deviation of the shin from the outside with the broken inner condyle and vice versa, i.e. In a healthy way.

Fractures of one condyle of the femur or shin with displacement are treated conservatively. Eliminate hemarthrosis. A 2% solution of procaine (20 ml) is injected into the joint cavity and repositioned by maximizing the tibial deviation in the direction opposite to the fractured condyle. Fingers try to press a fragment to the mother box. Manipulation is performed on the unbent limb. The achieved position is fixed by circular plaster bandage from the inguinal fold to the ends of the fingers in a functionally advantageous position.

The terms of permanent immobilization for fractures of one condyle of the thigh are 4-6 weeks. Then the longite is transferred to the removable and proceeds to restorative treatment, but prohibits the load on the leg. After 8-10 weeks, immobilization is eliminated and, after X-ray control, it is allowed to proceed cautiously on the leg with crutches, gradually increasing the load. Free walking is possible no earlier than 4-5 months. Workability is restored in 18-20 weeks.

Tactics for fractures of the condyles of the lower leg are the same. Terms of permanent immobilization 4-6 weeks, removable - 8 weeks. Work is allowed after 14-20 weeks.

In fractures of two condyles with displacement of fragments, comparisons are achieved by pulling along the limb axis and squeezing the condyles from the sides with hands or special attachments (vice). The limb is fixed with a circular bandage. If the reposition is not successful, skeletal traction is applied for a calcaneal bone with a weight of 7-9 kg. After one or two days, an X-ray inspection is performed. During this time, the fragments are compared along the length, but sometimes there is a shift in width. It is eliminated by lateral compression of the fragments and, without stopping the thrust, a gypsum tutor is placed from the upper third of the thigh to the foot. The limb is placed on the tire and skeletal traction continues. It should be noted that stretching, repositioning, gypsum immobilization is carried out on the limb, which has been bent to the angle of 175 °. The cargo is gradually reduced to 4-5 kg. Extension and permanent immobilization are eliminated after 8 weeks, then proceed to rehabilitative treatment. Removable Longe is shown for 8-10 weeks with a fracture of the condyles of the thigh, for 6 weeks - with a fracture of the condyles of the lower leg. Workability is restored in patients with fractures of both condyles of the femur or lower leg after 18-20 weeks.

Surgical treatment of fracture of the condyles of the femur and lower leg

Surgical treatment consists in the most accurate comparison of fragments and their tight binding. This can be achieved in various ways. One of them - compression osteosynthesis, developed in our country by IR. Voronovich and F.S. Yusupov. Its essence lies in the fact that through the fragments spreading across the width they hold two spokes with fixed platforms. The end of the spoke, opposite the obstructed pad, is fixed in the bracket. It is pushed apart, creating compression of bone fragments. Similar compression of the fragments can be performed in external fixation devices with the help of additional spokes with stops. The method is quite effective, but requires strict adherence to asepsis, since the spokes create a channel that communicates through the fracture line the joint cavity with the external environment.

Other types of rigid fixation of fragments consist in their connection by screws, bolts, plates and combinations of these devices.

Of all the modern fixatives used to treat patients with fractures of the condyles of the hip, the DCS design should be considered as the optimal one. It stably secures fragments, which makes it possible to avoid external immobilization of the limb and early to begin movements in the knee joint.

Fractures of the condyles of the lower leg are treated similarly to hip condyle fractures. It should again be recalled that these are intra-articular fractures, so it is necessary to strive for an ideal comparison of the fragments. Unfortunately, even an open reposition often presents significant difficulties, especially if it is not performed in the first 3-4 days after the injury.

Correlations of fragments are achieved due to the tension of the collateral ligaments by deflecting the shin to the inside-out, using various elevators, wide osteotomes, etc. Control over the reposition is performed palpation from the articular surface and by radiographic examination.

If the reposition is successful, the fragments should be fixed with 2-3 Kirschner knitting needles and only then go on to the final method of osteosynthesis in order to avoid a repeated displacement of the fragments at the time of manipulation.