FRACTURE OF THE CONDYLES OF FEMUR


This is not a common injury. The nature of lesion may vary from a simple to that of a severe type of injury. Considerable disabilities are likely to be produced by this injury. Most of the complications can be anticipated and measures can be taken to avoid development of these conditions.

MECHANISM OF INJURY

The lesion is usually produced by a direct violence and is mostly seen in an automobile accident. The violence may be transmitted from below to upward, as it happens after a fall from a height. The tibial condyles from below strike against the femoral condyles above. The lesion may involve one or both condyles of the femur or may produce an intercondylar fracture.

DIAGNOSIS

Clinical examination: There are a pain, swelling and tenderness around the knee-joint. Movements of the knee are restricted and painful. Effusion of the joint due to hemarthrosis can be elicited.

X-ray: The nature of fracture is demonstrated by radiology.

The fracture involves the articular surface of the femur. The aim of the treatment is to obtain the maximum congruency of the normal joint surface.

Many cases may be successfully treated without resorting to operative intervention. The result of closed reduction must be critically assessed by x-ray. By experience it is easy to decide whether the condition requires surgery or conservative method. The procedure is performed under general anaesthesia.

Aspiration: The haemoarthritis is fullas pirated and the joint cavity is emptied.

Reduction: Traction and counter-traction are applied on the leg. The surgeon then applies a compression force on the fractured segments to correct the displacement.

Traction: After manipulation, skeletal traction is applied by inserting Steinmann’s pin at the level of the tibial tubercle. The limb is placed on a Thomas splint with the knee-flexion piece. Traction is applied by putting about 10-15 lbs. of weight.

Post-immobilization management: Immediate check x-ray is taken. Quadriceps and knee-exercises are started from the very beginning.

Union: Union takes place in about 8 weeks when the traction is removed.

Ambulation: After one week’s rest in bed following the removal of traction, the patient is advised to start non-weight bearing with the aid of crutches. This is maintained for a period of 6 weeks.

Plaster immobilization: Some surgeons prefer plaster immobilization rather than applying skeletal traction. The plaster extends from the groin to the metatarsal heads of the foot. The cast is usually removed after 3 months. The progress of union is the same as that of the skeletal traction. The stiffness of the knee-joint is comparatively more common when treated by plaster cast than with traction.

Operative reduction and internal fixation:

The operation is specially indicated in cases of failure of closed reduction. This is applicable more so amongst the young adult patients. The result of the operation is certainly better when performed with skill and judgement. It is difficult to perform internal fixation in cases of grossly comminuted fracture. The internal fixation requires different orthopedic implants such as orthopedic bone screws etc. These are supplied by the trauma implant distributors.

Basic technique of operative fixation: Internal fixation can be achieved by screws and plate or by Rush nails in the case of intercondylar fracture.
FRACTURE OF THE CONDYLES OF FEMUR FRACTURE OF THE CONDYLES OF FEMUR Reviewed by Glam Treat on 01:29:00 Rating: 5

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