Fracture Of Lateral Femoral Condyle Research Articles

Outcomes After Single-Stage Anatomic Multiligament Knee Reconstruction With Early Range of Motion in Adolescents.

Multiligament knee injuries (MLKI), rare in adolescents, are challenging injuries that require complex surgical reconstruction. Historically, nonanatomic reconstructions have been associated with prolonged immobilization and failure to restore normal knee biomechanics, resulting in arthrofibrosis and high rates of graft failure. To describe the clinical and patient-reported outcomes (PROs) for adolescent patients treated with single-stage anatomic multiligament knee reconstruction. Case series; Level of evidence, 4. A single-center retrospective study was performed of patients ≤18 years old who underwent reconstruction of MLKIs by a single surgeon between 2014 and 2019 using a single-stage anatomic technique, with protected weightbearing and early range of motion. Complications were defined as infection, arthrofibrosis, deep vein thrombosis (DVT) or pulmonary embolus, and secondary surgery. PROs, including the pediatric version of the International Knee Documentation Committee (Pedi-IKDC) and the Tegner activity score, were obtained at a minimum of 2 years postoperatively. Included were 30 patients (21 male, 9 female; mean age, 15.4 years). The most common ligamentous reconstruction types were anterior cruciate ligament (ACL) + fibular collateral ligament (12 patients; 40%) and ACL + medial collateral ligament (9 patients; 30%). Three patients (10%) had secondary surgeries, including irrigation and debridement of a granuloma, a staged osteochondral allograft transplantation to a lateral femoral condyle impaction fracture, and repair of a medial meniscal tear and lateral femoral condyle fracture associated with new injuries 2 years after ACL + fibular collateral ligament reconstruction. Two patients (7%) developed arthrofibrosis and 1 patient (3%) developed DVT. PRO scores obtained at a mean of 37 months postoperatively included a mean Pedi-IKDC of 87 (range, 52-92) and a median highest Tegner score at any point postoperatively of 9 (range, 5-10). Of the patients who were athletes before their injury, 70% returned to the same or higher level of sport postoperatively. Reconstruction of MLKI in this series of adolescents with single-stage anatomic techniques and early range of motion resulted in low rates of secondary surgery, few complications, and good knee function as well as PRO scores at mean 3-year follow-up.

Fixation of a chondral lateral femoral condyle fracture in a 13-year-old boy following patella dislocation using a new suture technique.

Osteochondral or, even more rarely, purely chondral fractures of the lateral femoral condyle following patella dislocation in adolescents are relatively infrequent. Various fixation methods are described in the literature, ranging from traditional screws to bioabsorbable constructs or the use of anchors. Each method possesses its own advantages and limitations. Here, we present a case involving a 13-year-old boy with a large purely chondral fracture of the lateral femoral condyle after patella dislocation, initially overlooked. We introduce a cost-effective suture-bridge technique for the fixation of this fracture, which eliminates the need for a second operation and has yielded favorable outcomes. It is important to know that fractures of this type can be easily overlooked, necessitating a high index of suspicion and the utilization of advanced imaging techniques to prevent potential long-term catastrophic outcomes for the knee joint.

Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report

Osteochondral fracture (OCF) in weight-bearing area of lateral femoral condyle (LFC) is a rare combined injury caused by patellar dislocation. A 15-year-old female student accidentally sprained her right knee while participating in sports activities. The patient felt pain in his right knee and limited movement. After hospitalization, the patients underwent computed tomography scan and magnetic resonance examination. According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. The functional and radiographic outcome were satisfactory at 18 months after operation. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical.

A Case Report on Tibial Plateau Fracture Fixed with Combination of Hybrid and Knee Spanning Fixator in Gustilo-Anderson Type 3b Injury

Tibial plateau fractures involve the intra-articular portion of the proximal tibia with or without metaphyseal extension. Here, we present the case of a 25-year-old male patient presented with Schatzker type 6 tibial plateau fracture associated with a lateral femoral condyle fracture and a vertical patella fracture fixed with a combination of hybrid ring fixator, cannulated cancellous screws, and a knee spanning frame in Gustilo-Anderson type 3 B injury. The purpose of this case report is to highlight the surgical challenges faced in such types of cases that include the Gustilo and Anderson type 3 B injury with complicated fracture morphology, the implant to be used with his current economic status, and the limited investigations available.

Knee Pain in a 7th Grade Runningback

AUTHORS: Michael J. Bradburn, E. Ray Stewart, E. Lyle Cain AFFILIATION: The University of Alabama, Tuscaloosa, AL, Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL TITLE: Knee pain in a 7th Grade Runningback CASE HISTORY: Patient is a 13-year-old male 7th grade runningback who sustained a left knee injury at practice. He reported running the football and dragging a defender who was holding onto the patients left leg. He felt a pop in his knee and reported immediate swelling. He was evaluated later that night at the Varsity football game and was referred to the sports medicine office in Tuscaloosa for evaluation. PHYSICAL EXAM: Inspection: non-weight bearing left lower extremity, assistance with crutches Mild ecchymosis, severe effusion, maximal tenderness: lateral joint line, medial patellar, moderate swelling Tests: left knee: negative Lachman’s, guarded medial and lateral McMurray’s. Negative valgus and varus stress, negative anterior and posterior drawer Range of motion left knee: painful active and passive range of motion, 45 degrees of flexion active and passive, 0 degrees extension active and passive Positive patellar apprehension on left Lower extremity strength is normal Lower extremity neurovascular exam is normal DIFFERENTIAL DIAGNOSIS #1: patellar subluxation #2: femoral condyle fracture #3: lateral collateral ligament sprain #4: lateral meniscus tear #5: femoral / tibial bone contusion TESTS AND RESULTS: X-ray Knee 4 views Left: avulsion fracture of lateral femoral condyle – minimally displaced MRI Left knee without contrast: popliteus tendon rupture with retraction. Edema surrounding ACL FINAL / WORKING DIAGNOSIS: Left popliteus tendon femoral avulsion DISCUSSION: Isolated popliteus tendon rupture is a rarely reported finding in the literature. The vast majority of popliteus tendon ruptures occur in combination with other ligamentous injuries specifically in the posterolateral structures of the knee. Generally, reported cases are treated non-operatively with a high rate of return to play at previous level. OUTCOME: Patient was evaluated by an orthopedic surgeon at Andrews Sports Medicine and Orthopaedic Center in Birmingham, AL and underwent arthroscopic left popliteus tendon repair RETURN TO ACTIVITY AND FOLLOW UP: After surgery the patient followed an ACL rehabilitation protocol, weight bearing as tolerated in a controlled motion brace, locked in extension for two weeks and began physical therapy after his initial post-operative appointment two weeks after surgery. At his 2-week post-operative appointment he could wean off crutches and weight bear as tolerated with his knee brace locked in extension. Physical therapy following ACL rehab protocol was initiated for the next 4 weeks, allowing for range of motion exercises out of the brace. After six weeks total he was released to return to full activities.

Femoral Giant Cell Tumor in a Patient with Surgically Treated Femoral Condyle Fracture: Misdiagnosis or Coincidence?

Abstract Introduction. Giant-cell tumor of bone (GCTB) is a benign tumor with an unpredictable evolution, representing 4-5% of all primary bone tumors and 15% of benign bone tumors usually affecting 20-45 years old adults. The predilect location is the distal femur, proximal tibia, and distal radius. Case presentation. We report the case of a 31-year-old male, regardless of medical history, admitted in the emergency department (ED) for significant pain and functional impairment of the right knee, after suffering a traumatic event. Clinical examination and imaging tests established the diagnosis of lateral femoral condyle fracture. Therefore, osteosynthesis with 4 screws was performed. Postoperative evolution was uneventful until one year later when the patient presented to the ED for pain and inflammatory aspect of the right knee, but with no history of trauma during this time. The imagistic exams of the right knee (X-ray, magnetic resonance imaging and scintigraphy) detected a tumor of the lateral femoral condyle that also affected the osteosynthesis material. Thus, the removal of screws and histopathological exam were performed, the latter establishing the diagnosis of GCTB. Taking into consideration radiological and histological aspects of the tumor and relating them to the clinical findings, the GCTB was classified in stage III Enneking. The patient underwent surgery, segmental resection of the tumor in oncological limits and arthroplasty with modular tumoral prosthesis was performed. Postoperative results at 6 and 12 months according to Musculoskeletal Tumor Society Scoring System were very good. The key feature of this case consists of post-osteosynthesis appearance of the GCTB given the fact that only 3 cases of GCTB affecting the screw site were reported in literature.

Osteochondral fracture of patella

Osteochondral fractures of patella are commonly associated with acute patellar dislocations and are frequently missed or misinterpreted in initial radiograph. Usually such fractures need surgical treatment. This article presents a case of a 13-year-old girl who sustained a twisting knee injury while doing exercise (yoga) and sustained a small osteochondral fracture of the central part of the patella, displaced inferolaterally, lying close to lateral femoral condyle. The initial radiograph was misinterpreted as chip fracture of lateral femoral condyle. Diagnosis of osteochondral fracture of patella was confirmed only during the surgery. This case needs to be reported as the osteochondral fracture of patella was not only missed but also misinterpreted.

Osteochondral Fracture Lateral Femoral Condyle Treated with ORIF Using Z-Plasty: A Modification of Coonse and Adams Approach

Osteochondral fractures of lateral femoral condyle are common in adolescents and young adults. They are usually caused by direct trauma or twisting injuries of the knee. We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteen-year-old male with a positive history of significant weight gain of 5 kilograms in last six months. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Adequate exposure was achieved by doing Z-plasty of quadriceps apparatus. The fracture was treated with open reduction and internal fixation using Herbert's screws. Medical management in the form of vitamin D and calcium along with testosterone was given. After the surgery, full weight-bearing was allowed at three months. At one year followup, patient has good quadriceps function without any weakness of the muscle.

Lateral Femoral Condyle Fracture and Patella Dislocation in Below-the-Knee Amputation

Treatment of a 42-year-old patient with below-the-knee amputation from 15 years ago who presented with lateral femoral condyle fracture and patella dislocation is described. In addition, the advantages of transtibial over transfemoral amputation are discussed.

Custom-made lateral femoral condyle replacement for traumatic bone loss: A case report

We report the case of a 24 year-old patient who underwent a novel treatment for a lateral femoral condyle fracture. The fracture was associated with extensive joint line depression and not considered suitable for conventional fixation techniques. Existing reconstructive options for such situations include unicondylar osteoarticular allograft, arthrodesis and arthroplasty. However, these techniques all present significant disadvantages, particularly in the management of active patients. We report our medium-term results following reconstruction using a custom-made lateral femoral condyle hemiarthroplasty replacement. Follow-up at 48 months revealed an excellent, pain-free level of function, with an Oxford Knee Score of 46/48, a Knee Society knee score of 87/100 and a functional score of 100/100. Radiographs demonstrated no evidence of prosthesis loosening or migration and no erosion of the lateral tibial plateau. The technique allows preservation of the remaining normal joint surface of the femur that may promote earlier and better restoration of function. Furthermore, the isolated condyle hemi-replacement maximises bone preservation, facilitating future anticipated revisions. The procedure presents an attractive alternative to other surgical options and their attendant problems. Further investigation into this technique is required before widespread adoption, though such studies will be compromised by the relative rarity of patients in whom the technique is indicated.

Intra-articular lateral femoral condyle fracture following an ACL revision reconstruction

Lateral femoral condyle fractures following an ACL reconstruction are rare. To our knowledge, this is the first case report of a lateral femoral condyle fracture following a revision ACL reconstruction. The patient's fracture was intra-articular, had a significant amount of soft tissue damage, and was further complicated by a large defect involving the bone tunnel from the ACL revision reconstruction. The patient was treated with an open reduction and internal fixation and recovered well.

An aged case of TKA for osteochondral fracture of lateral femoral condyle caused by the dislocation of patella

An aged case of TKA for osteochondral fracture of lateral femoral condyle caused by the dislocation of patella

Fixation of the Femoral Condyles: A Mechanical Comparison of Small and Large Fragment Screw Fixation

To compare the stability achieved using two 6.5-mm screws versus two or four 3.5-mm screws for the fixation of a unicondylar distal femur fracture. A fracture model was created in femoral synthetic composite bones to simulate a lateral femoral condyle fracture (AO/OTA 33-B1). Fixation was performed using three different types of screw constructs: 1) two 6.5-mm cancellous screws inserted using the lag technique, 2) two 3.5-mm cortical screws inserted using the lag technique, and 3) four 3.5-mm cortical screws, with two inserted using the lag technique and two as position screws. After reduction and fixation, the constructs were axially loaded in a material-testing machine. Main outcome measurements were the mean load required to displace the osteotomy site 1 and 2 mm as well as the mean stiffness of the different fixation methods. The 6.5-mm construct required 56% more load to displace the osteotomy fragment 1 mm than the two 3.5-mm construct required (p < 0.0001), and 40% more load than the four 3.5-mm construct required (p < 0.0001). At loads that caused 2 mm of osteotomy displacement, these differences increased to 62% (p < 0.0001) and 48% (p < 0.0001), respectively. The mean loads needed to displace the osteotomy site were 28% higher for 1 mm of displacement (p = 0.003) and 27% higher for 2 mm of displacement (p = 0.03) for the four 3.5-mm screw construct compared with those needed for the two 3.5-mm group. The mean stiffness for the 6.5-mm group (1312.5 N/mm) was significantly higher than for the four 3.5-mm construct (784.2 N/mm; p < 0.0001) and the two 3.5-mm screw construct (409.4 N/mm; p < 0.0001). The difference in stiffness between the 3.5-mm groups was significant as well (p < 0.0001). Stabilization of a unicondylar distal femur fracture with two 6.5-mm cancellous screws provides the most rigid and stable fixation. If small fragment screws are used, a minimum of four 3.5-mm cortical screws should be used to approximate the mechanical stability of two 6.5-mm screws.

Minimally Invasive vs. Standard Total Knee Arthroplasty : A Prospective Randomized Comparison Study

Purpose : A prospective randomized study was performed to compare the clinical results of standard vs. minimally invasive TKA (MIS TKA), and to identify the preoperative factors that help to figure out the indications of MIS TKA. Materials and Methods : Eighty patients with osteoarthritic knees were randomized to standard TKA and MIS TKA groups. The operations were performed by one senior author with the same TKA system. Preoperative evaluation included body mass index (BMI), range of motion (ROM), deformity, and WOMAC and Knee Society scores. Operative factors were evaluated, including length of skin incision, operation time, and operative complications. Postoperative evaluation was performed daily until discharge from hospital, at 1 month, 3 months, 6 months, and 1 year postoperatively, including blood loss, amount of epidural anesthesia, visual analog scale (VAS), ROM, possible day of active straight leg raising (SLR), possible day of discharge, complications, WOMAC and Knee Society scores, patient's satisfaction with the operative scar, and radiological evaluation. Results : There were statistically significant differences in daily VAS, operation time, length of skin incision, and possible day of SLR (p＜0.05). There were no significant differences in other clinical aspects that were compared in this study. Complications occurred only in MIS group; 1 partial tear of MCL and 1 fracture of lateral femoral condyle. Preoperative ROM or BMI was not correlated with longer operation time. Significantly longer operation time was observed when both the preoperative fixed flexion contracture and varus deformity were greater than 10 degrees, or one or both of them was greater than 15 degrees (p＜0.05). Conclusion : MIS TKA has the advantage of less pain, shorter skin incision, and earlier possible SLR in the early postoperative period, but it requires a longer operation time and careful surgical technique. The surgeon should select the MIS procedure by carefully considering its advantages and disadvantages. Both the preoperative flexion contracture and varus deformity greater than 10 degrees, or one of them greater than 15 degrees seems to be the relative contraindication of MIS TKA from the result of this study.

PLAIN FILM MANIFESTATIONS OF ACL INJURY

ACL injuries are common but often difficult to diagnose acutely by clinical examination alone. The Segond fracture, avulsion fracture of the anterior tibial spine, impacted lateral femoral condyle fracture, and fracture of the posterior lateral tibial plateau are radiographic signs often associated with ACL injury. It is important to recognize the significance of these subtle abnormalities and if found, further evaluation should be done to identify the presence and the extent of ACL injury as well as potential injury to other components of the knee joint. MRI is the imaging method of choice in these patients. Early diagnosis and treatment of knee joint abnormalities may help prevent or diminish long-term disability.