We report six cases of insufficiency fractures of the medial femoral condyle responsible for severe mechanical pain in the medial knee compartment in the absence of any identifiable precipitating factor. Femoral medial condyle fracture is a rare fracture. How displaced are "nondisplaced" fractures of the medial humeral epicondyle in children? Physio.co.uk have clinics located throughout the North West. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. Catgut suture as a means of internal fixation has proved to be inadequate, in that it has often resulted in this complication. 18 (2):120-34. Surgical treatment of femoral medial condyle fracture with lag screws If the fragment is incarcerated in the joint, the incidence of ulnar nerve dysfunction can reach 50%. Please note: Our Online Booking tool is currently down, please contact us on 0330 088 7800 to arrange your appointment and we will honour any online booking discount. Bensahel H, Csukonyi Z, Badelon O, Badaoui S. Fractures of the medial condyle of the humerus in children. Bookshelf official website and that any information you provide is encrypted [QxMD MEDLINE Link]. Res. Dodds SD, Flanagin BA, Bohl DD, DeLuca PA, Smith BG. Go to: Consultations The femoral condyles are on the ball-shaped end of the femur which meet at the knee joint. Dakar Med. [QxMD MEDLINE Link]. Subchondral hypointense fracture lines tend to resolve with conservative therapy. 18. [2, 3, 4, 6, 7, 8, 9, 10, 12, 31]. 1995 Jul-Aug. 15 (4):444-8. Subchondral insufficiency fracture of the knee. Informed consent was obtained for the surgery. J Pediatr Orthop. Medial epicondyle fractures of the humerus: how to evaluate and when to operate. Femoral Condyle Fractures are a painful condition which can result from trauma injuries to the thigh bone and/or knee. Skeletal Radiol. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-2079, View Frank Gaillard's current disclosures, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, Spontaneous osteonecrosis of the knee (SONK), Spontaneous osteonecrosis of the knee (SPONK), Spontaneous insufficiency fracture of the knee (SIFK), Subchondral insufficiency fracture of the knee (SIFK). Epicondyle fractures can be caused by traction forces. We used a proximal tibial plate upside down as a buttress plate for femoral medial condyle fracture. Materials and methods [QxMD MEDLINE Link]. Please enable it to take advantage of the complete set of features! We used a locking compression plate - proximal tibial plate 4.5/5.0 (Depuy Synthes TRAUMA) as a buttress plate. Subchondral hypointense fracture lines tend to resolve with conservative therapy. 2002 Nov;31(11):615-23. doi: 10.1007/s00256-002-0575-z. Orthop. 1965 Jul-Aug. 41:43-50. Fractures of the mandibular condyle: evidence base and current concepts of management. [39] Other controversial relative surgical indications include complete ulnar nerve dysfunction after an injury or reduction attempt and valgus instability in high-demand athletes. J Bone Joint Surg Am. 2013 Feb;42(2):177-85. doi: 10.1007/s00256-012-1492-4. Clinical outcomes were variable, with 23.9% (11/46) requiring TKA. Bangil M, Soubrier M, Dubost JJ, Rami S, Carcanagues Y, Ristori JM, Bussiere JL. and transmitted securely. [QxMD MEDLINE Link]. Curr Opin Pediatr. Unauthorized use of these marks is strictly prohibited. Su HC, Chou SH, Ho HY, Lu CC, Tien YC, Shih CL, et al. 30 (3):253-63. Disclaimer. Radiography must be repeated until the union is ensured. -. Without adequate nourishment, the affected portion of bone dies and gradually collapses. Ehlinger M., Ducrot G., Adam P., Bonnomet F. Distal femur fractures. You will likely be referred for CT, X-ray or MRI scans to determine the extent of the injury. [Treatment of medial epicondylar apophyseal avulsion injury in children]. Diagnosis is made radiographically with CT studies often required to assess for intra-articular extension. the contents by NLM or the National Institutes of Health. A lag screw is then placed to maintain and compress the fracture fragment. Knee. 2019 Aug. 45 (4):757-761. [20, 21, 40]. Behrman MJ, Shelton ML. [QxMD MEDLINE Link]. J Orthop Surg (Hong Kong). We have immediate appointments available today. [QxMD MEDLINE Link]. Closed reduction with cast immobilization is adequate for nondisplaced stable medial condyle fractures. 91 (2):W12-4. J Bone Joint Surg Am. A progressive cubitus varus deformity may develop as a consequence of growth inhibition or avascular necrosis (AVN) of the medial humeral condyle. This was treated with a supracondylar wedge osteotomy to restore ROM and correct the cubitus varus deformity. 2009 Mar. Epub 2015 May 26. Note normal location somewhat posteriorly on distal humerus. They are covered by articular cartilage and function as a shock absorber for the knee. 4010 W. 65th St. Anteroposterior view after fixation. . Plain radiography and computed tomography showed oblique fracture of the femoral medial condyle. 2001 Sep. 83 (9):1299-305. 213 (5): 963-982. In preparation for ORIF, the arm is placed in a posterior splint for stabilization, elevated, and treated with ice packs to decrease swelling. I can run, bike, & climb mountains. [QxMD MEDLINE Link]. These are fractures that occur in the coronal plane rather than the more common sagital plane. Pathy R, Dodwell ER. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. A femoral condyle is the ball-shape located at the end of the femur (thigh bone). Internal fixation allows this early physical therapy to be instituted without compromising the reduction. The post-operative plain radiography and computed tomography. Accessibility Skeletal Radiol. Here, we present a case with femoral medial condyle fracture treated with a proximal tibial plate. official website and that any information you provide is encrypted Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. Dhillon M.S., Mootha A.K., Bali K., Prabhakar S., Dhatt S.S., Kumar V. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. John J Walsh, IV, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Christian Medical and Dental Associations, American Society for Surgery of the HandDisclosure: Nothing to disclose. A loss of elbow extension of 10-15% can be expected in up to 20% of cases, and this appears to be correlated more with prolonged immobilization than the fracture itself. 2015 Jul;19:95-102. doi: 10.1016/j.ijsu.2015.05.027. Keywords: However, no currently available anatomical plates fit the femoral medial condyle. Surgery is the gold standard for displaced fractures or to enable rapid return of knee function. Zukotynski BK, Alswang JM, Silva M. Medial Condyle Fractures of the Humerus in the Pediatric Population: Diagnostic Challenges: A Report of 3 Cases. Acta Orthop Scand. Another type of treatment can involve taking a plug of bone and cartilage, called an osteochondral transfer, from area of the knee and transferring it to the other area of the knee. 28 (2):2309499020921755. Injury. 2010;29: 38-42. Traumatol. Fractures of the femur are more commonly at the top, at the neck of the femur, or in the main shaft. Nonunion Share cases and questions with Physicians on Medscape consult. 2009 Mar;17(1):71-4. doi: 10.1016/j.cxom.2008.10.003. Subchondral insufficiency fracture of the knee: review of current Medial epicondyle fractures also may be treated in a closed fashion if the medial epicondyle is nondisplaced, minimally displaced, or even displaced up to 15 mm (see the image below). 12. [QxMD MEDLINE Link]. Lotke PA, Nelson CL, Lonner JH. PMC Philadelphia: Wolters Kluwer; 2018. As with any fracture reduction, periosteum and bone fragments are cleared from the fracture site to allow anatomic reduction. The second involves ulnar nerve dysfunction, which may occur in 10-16% of cases. 2000 Mar-Apr. Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. Maugars Y, Dubois F, Berthelot JM, Dubois C, Prost A. Lafforgue P, Pham T, Denizot A, Daumen-Legr V, Acquaviva PC. PMC Surgical intervention may be recommended as a method of treatment whether that be the insertion of pins to stabilise the joint, to a complete knee replacement. The tibiofemoral joint is the largest weight-bearing joint in the body and takes large force when the joint is used in activities such as walking, running, and jumping. Orthop. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. HK wrote this paper. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. Partial or complete recovery may take months. There are two femoral condyles. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. Most avulsion fractures heal very well without surgical intervention. More profound ulnar nerve dysfunction has been observed to occur with manipulative reduction attempts, especially if closed manipulation of an incarcerated fragment is attempted. AJR Am J Roentgenol. The missing piece of the trauma armoury-medial femoral condyle plate. At Vitalis Physiotherapy, we tailor a unique treatment plan to aid in your recovery through: Your physiotherapist may also advise heat or ice application, rest and if necessary, pain medication. Res. 1. 2003 Aug;13(8):1843-8. doi: 10.1007/s00330-002-1775-6. An epidemiological analysis of 589 cases. 1987 Jan-Feb. 7 (1):54-60. 48 (12): 1961-1974. An incidental finding on MRI scan may not need treatment, and close observation may be indicated in these cases. In fractures with a vertical fracture line, a buttress plate is necessary to counteract the vertical shear forces. The ulnar nerve is identified and protected and may be transposed anteriorly. Typically these injuries are related to a fall from a height or a road traffic incident. This is often associated with delayed fixation and closed head injuries. The femoral condyles are the lower part of the femur where the shaft widens to two condyles, one medial and one lateral. If the epicondyle is fragmented, excision of the fragment and fixation of the flexor-pronator origin and medial collateral ligament (MCL) to bone with an alternative form of fixation (eg, suture anchors) may be used. J Am Acad Orthop Surg. Impaction Fracture of the Medial Femoral Condyle assessment of the anterior cruciate liga-ment with the anterior drawer and Lach-man tests was negative for laxity. Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. The plate was bent to fit the bone surface and fixed with cortical and locking screws. Anteroposterior view of displaced medial epicondyle fracture after reduction. Multiple treatment options are available for both traumatic osteochondral injuries and OCD lesions, with important determining factors of treatment being skeletal maturity of the patient, instability of the fragment . Iowa Orthop J. National Library of Medicine Knee Fracture Management in the Emergency Department - Medscape Mon - Fri: 8am - 8pm A posterior splint is then applied for at least 7-10 days until ROM is initiated. The force of this event may even fracture other bones within the knee or legs. The site is secure. We used a locking compression plate - proximal tibial plate 4.5/5.0 (Depuy Synthes TRAUMA) as a buttress plate. Hoffa fracture of the femoral condyle: Injury mechanism, classification Cartil. Eur Radiol. [Posttraumatic temporomandibular joint ankylosis: clinical development and surgical management]. Incarcerated medial epicondyle fracture following pediatric elbow dislocation: 11 cases. Case presentation: Medscape Education. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A valgus deformity also can result from imperfect restoration of position. This may be as early as 3 weeks for nondisplaced fractures and is usually about 6 weeks (occasionally as long as several months) for displaced fractures. Karlsson MK, Herbertsson P, Nordqvist A, Besjakov J, Josefsson PO, Hasserius R. Comminuted fractures of the radial head. Intraoperative femoral condyle fracture is a significant but rarely reported complication during primary total knee arthroplasty (TKA). The implant fitted well and enhanced joint stability. Fracture of the medial condyle of the humerus. Oper Orthop Traumatol. This site needs JavaScript to work properly. An osteochondral detachment from the subchondral bone can be seen (arrow). We gained access to the joint through the medial parapatellar approach, anatomical restoration of the joint surface was achieved with clamp application. Please enable it to take advantage of the complete set of features! J Pediatr Orthop. 2016 Aug;47(8):1761-9. doi: 10.1016/j.injury.2016.05.026. [QxMD MEDLINE Link]. The locking compression plate for proximal tibia is an acceptable solution for femoral medial condyle fracture. Pappas N, Lawrence JT, Donegan D, Ganley T, Flynn JM. Accurate apposition of the fracture surfaces is important to reduce the risk of growth-plate disturbance and to prevent loss of motion due to articular incongruence. 2013;99:353360. Distal femur fractures are traumatic injuries involving the region extending from the distal metaphyseal-diaphyseal junction to the articular surface of the femoral condyles. A smaller defect with good cartilage shoulders can potentially be treated with a microfracture. Federal government websites often end in .gov or .mil. She did not present loss of consciousness, central nervous system dysfunction, or paralysis. V. Distal humerus. Most of the other complications associated with medial epicondyle fractures are considered minor and do not result in a loss of function. Diagnostic imaging will be necessary and acute treatment of rest, ice, medication and in some cases surgery. Disclaimer. EDINA- CROSSTOWN OFFICE 11 (2):117-20. Epub 2013 Sep 7. J Pediatr Orthop. All you need to do is just give us a call on 0410 559 856 and request an initial appointment. 1997 Feb-Mar. Before Malunion can result in loss of motion or angulation. Would you like email updates of new search results? If one fits all of these criteria, or one can be treated with surgery to correct these criteria, then one could be a candidate for a cartilage resurfacing procedure. The patient had an uneventful postoperative recovery. Femoral Condyle Fractures - Symptoms, Causes, Treatment | Physio Gentle active range-of-motion (ROM) exercises may begin within 1 week after injury. Also known as a bone marrow lesion, BME occurs when arthritis, an injury, or a fracture damages the normal bone structure. Louahem DM, Bourelle S, Buscayret F, Mazeau P, Kelly P, Dimeglio A, et al. In the later stages features seen include: complicating subchondral fracture with periosteal reaction, On radiographs the Koshino classificiation is sometimes used which is as 18, stage II: radiolucency in subchondral weight-bearing area, stage III: expanded lucent area surrounded by sclerosis, subchondral bone collapse, stage IV: osteophytes and osteosclerosis on affected condyle. Bone insufficiency fractures as an inaugural manifestation of primary hyperparathyroidism. Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort. Operative strategy in postero-medial fracture-dislocation of the proximal tibia. Spontaneous osteonecrosis of the knee: tibial plateaus. Arthrographic diagnosis of elbow injuries in children. This type of surgery is considered the gold standard because the cartilage has an excellent chance of healing and if one follows a proper rehabilitation program with low impact activities only for the first year after implantation, there are excellent outcomes described in the literature for this procedure. Sunday: 9am - 4pm. This is usually related to an overgrowth of the medial condyle. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. Please confirm that you would like to log out of Medscape. Misdiagnosis or inadequate early treatment increases the risk of complications such as loss of movement and angulation. We recommend a consultation with a medical professional such as James McCormack. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Ip D, Tsang WL. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture. Philadelphia: Lippincott Williams & Wilkins; 2000. MILCH H. FRACTURES AND FRACTURE DISLOCATIONS OF THE HUMERAL CONDYLES. A 80-year-old woman fell down 15 steps at her home and reported to our hospital with severe right knee pain. 16 (2):117-23. This mean that a Hoffa fracture will be seen on X-ray or MRI from a side view. Harrison RB, Keats TE, Frankel CJ, Anderson RL, Youngblood P. Radiographic clues to fractures of the unossified medial humeral condyle in young children. Abstract. The patient was admitted to our hospital for open reduction and internal fixation to be performed the following day. Treatment and Rehabilitation of Fractures. Editorially reviewed, not externally peer-reviewed. Postoperative radiographs confirmed anatomical reduction, and the patient achieved a good result. When the loss is related to another complication, such as nonunion, malunion, or heterotopic ossification, it can be significant. In fractures with a vertical fracture line, a buttress plate is necessary to counteract the vertical shear forces. Plate-and-screw fixation is another option. -, Ehlinger M., Ducrot G., Adam P., Bonnomet F. Distal femur fractures. Nevertheless, there are no available anatomical plates that fit either the femoral medial condyle or fracture fixation, except for the relatively short plate developed for distal femoral osteotomy. A displaced medial condyle fragment or instability of the fragment with closed reduction is an indication for open reduction with rigid internal fixation. 2. [20, 21, 40, 31, 42]. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. 3. In many studies, including long-term follow-up reports, patients treated nonsurgically had results similar to those of patients treated surgically, even for fracture fragments displaced as much as 15 mm. Cause Osteonecrosis develops when the blood supply to a segment of bone is disrupted. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. If employed, this maneuver is usually performed in the operating room with the patient under general anesthesia. 7. An official website of the United States government. Here, we report a case of femoral medial condyle fracture treated with lag screws and proximal tibial plate as a buttress plate. At the time the article was last revised Yuranga Weerakkody had North Am. J Clin Orthop Trauma. Published by Elsevier Ltd.. All rights reserved. Careers. A large bone fragment was identified attached to the MCL, of which the MCL is intact. Depasquale R, Fotiadou A, Kumar DS, Lalam R, Tins B, Tyrrell PN, Singh J, Cassar-Pullicino VN. Bookshelf [QxMD MEDLINE Link]. PMC 9. It is important that we treat the patient and not treat the MRI scan because some patients may have a cartilage defect and because they have normal strength and motion of their knee they may not have symptoms and may not have progression of the defect for a long time, if at all. Immediate treatment will need to be at the emergency room. Department of Orthopaedic Surgery, Yaizu City Hospital, Shizuoka, Japan. [QxMD MEDLINE Link]. Surg. 1970 Oct. 52 (7):1453-8. Ochi J, Nozaki T, Nimura A, Yamaguchi T, Kitamura N. Subchondral Insufficiency Fracture of the Knee: Review of Current Concepts and Radiological Differential Diagnoses. Zhonghua Kou Qiang Yi Xue Za Zhi. Long-term functional assessment has demonstrated similar results even with radiographic nonunion being apparent on most of the fractures treated nonoperatively.
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