Medial Condyle Fracture Research Articles

Outcomes in children with delayed surgical treatment of medial humeral condyle fractures.

Medial humeral condyle (MHC) fractures are easily overlooked in young patients. This can lead to delayed or incorrect diagnosis, resulting in delayed treatment, which is often associated with complications such as nonunion, osteonecrosis, fishtail deformity, and cubitus varus. The purpose of this study is to evaluate the clinical and radiographic outcomes in a cohort of paediatric patients who underwent delayed surgery for an untreated MHC fracture. From January 2017 to December 2022, we conducted a retrospective study of paediatric patients who underwent delayed treatment for a MHC fracture. In all cases, the initial diagnosis was incorrect and surgery was performed at least one week after injury. Patients were divided into two groups based on the time between trauma and surgery: Group 1 consisted of individuals who underwent early delayed treatment within seven to 30days of injury, while Group 2 consisted of those who underwent late delayed treatment more than one month after injury. Elbow function was assessed using the Mayo Elbow Performance Score (MEPS) and range of motion (ROM). The related literature was also reviewed (1970-2023). We enrolled 12 patients (7 boys, 5 girls); the average age at the time of surgery was 7.7years (range, 2-14years). Six patients underwent early delayed treatment (Group 1) while another six underwent late delayed treatment (Group 2). The mean time from injury to surgery was 17.7days (range, 7-30days) and 33.3months (range, 70days-9years) in Groups 1 and 2, respectively. Open reduction and internal fixation were performed via a medial approach in 11 patients, while one patient underwent closing wedge osteotomy and internal fixation to correct cubitus varus deformity. The mean duration of follow-up was 39.4months (range, 8-60months). The average MEPS score was 98.3 in Group 1 (range, 95-100) and 94.2 in Group 2 (range, 85-100; P = 0.21). The following postoperative complications were recorded: heterotopic ossification (n = 2), fishtail deformity (n = 1), MHC necrosis (n = 1), and reduction of elbow ROM (n = 1); one complication occurred in Group 1 and five occurred in Group 2 (P = 0.18). We reviewed nine related studies (n = 14 patients). Diagnosis of MHC fractures can be challenging in paediatric patients, especially in younger individuals with incompletely ossified trochlea. Patients requiring surgery for delayed MHC fractures with an unossified trochlea should undergo ORIF to prevent progressive varus deformity. On the other hand, in patients with cubitus varus and an already ossified trochlea, distal humeral osteotomy should be considered instead of ORIF. This will minimize the potential negative impact on joint mobility.

Functional outcome of patients presenting with isolated medial condyle fractures of femur in a tertiary care hospital

Isolated medial condyle fractures of the femur with an intact lateral condyle are a rare entity. These fractures require prompt diagnosis and anatomical restoration of joint surface to prevent post traumatic arthritis. Till date no suitable implant is available for fixation of these fractures. In this study we have used 4.5 recon plates and CC screws to fix these fractures. We aim to study the functional outcome of these fractures in a group of patients fixed with the above implants. The study was conducted in a group of patients presenting with isolated medial condyle fractures of femur in a tertiary care hospital. An ORIF was done and fractures were fixed with recon plates and lag screws and various parameters were evaluated such as range of motion of knee, average time to weight bearing, Lysholm knee scores, pain perception etc 20 patients were evaluated in the age group of 20-70 in a 5 year period. Majority of the patients had a very good functional range of motion of the knee and nearly 75% achieved union by 12-16 weeks. 70% of the patients had a low VAS score. Overall early diagnosis and prompt anatomical restoration of joint surface in isolated medial condyle fractures of femur led to favourable range of motion of knee, early radiological healing and low VAS score.

Determination of the ideal plate for medial femoral condyle fracture fixation: an anatomical fit and biomechanical study

BackgroundThe aim of this study is to determine the best plate to use as a substitute to fix a medial femoral condyle fracture.Materials and methodsThe first part is to measure the best fit between several anatomical plates including the Proximal Tibia Anterolateral Plate (PT AL LCP), the Proximal Tibia Medial Plate (PT M LCP), the Distal Tibia Medial Locking Plate (DT M LCP) and the Proximal Humerus (PHILOS) plate against 28 freshly embalmed cadaveric distal femurs. Measurements such as plate offset and number of screws in the condyle and shaft shall be obtained. The subsequent part is to determine the compressive force at which the plate fails. After creating an iatrogenic medial condyle fracture, the cadavers will be fixed with the two plates with the best anatomical fit and subjected to a compression force using a hydraulic press.ResultsThe PT AL LCP offered the best anatomical fit whereas the PHILOS plate offered the maximal number of screws inserted. The force required to create 2 mm of fracture displacement between the two is not statistically significant (LCP 889 N, PHILOS 947 N, p = 0.39). The PT AL LCP can withstand a larger fracture displacement than the PHILOS (LCP 24.4 mm, PHILOS 17.4 mm, p = 0.004).Discussion and conclusionBoth the PT AL LCP and the PHILOS remain good options in fixing a medial femoral condyle fracture. Between the two, we would recommend the PT AL LCP as the slightly superior option.

FUNCTIONAL OUTCOME OF ISOLATED MEDIAL FEMORAL CONDYLE FRACTURES MANAGED WITH PLATE OSTEOSYNTHESIS - A CASE SERIES

Purpose: Isolated medial condyle fractures of femur with metaphyseal extension are a rare type of injury around knee joint. Most common mode of injury is high-energy trauma (road traffic accident, fall from height, sports injury) and is commonly seen in younger age group. Is open reduction and internal fixation with locking plates is the treatment of choice for sagittal plane medial femur condyle fractures with metaphseal extension? Methods: We conducted a prospective study from 1st January 2018 to 31st December 2021 including 12 patients (seven males and five females) with isolated medial femur condyle fractures (AO 33B2.1). In our study, open reduction and internal fixation was performed with medial femur plates or T-buttress plates in all 12 cases. At final follow-up, functional outcome was evaluated using ‘functional criteria’, ‘IKS knee and function score’ and radiological assessment. Results: At final follow-up, out of 12 patients, 11 had excellent to good outcome according to ‘Kolmert Functional score’ and ‘IKS knee and function score’ were 83.33 and 78.33. At final follow-up, one out of twelve patients had extensor lag of 10 and flexion around 90. Conclusion: Isolated fractures of medial condyle with metaphyseal extension have good outcome in terms of function if proper anatomical reduction is achieved and supplemented with locking plates.

Biomechanical analysis of internal fixation system stability for tibial plateau fractures.

Background: Complex bone plateau fractures have been treated with bilateral plate fixation, but previous research has overemphasized evaluating the effects of internal fixation design, plate position, and screw orientation on fracture fixation stability, neglecting the internal fixation system's biomechanical properties in postoperative rehabilitation exercises. This study aimed to investigate the mechanical properties of tibial plateau fractures after internal fixation, explore the biomechanical mechanism of the interaction between internal fixation and bone, and make suggestions for early postoperative rehabilitation and postoperative weight-bearing rehabilitation. Methods: By establishing the postoperative tibia model, the standing, walking and running conditions were simulated under three axial loads of 500N, 1000N, and 1500N. Accordingly, finite element analysis (FEA) was performed to analyze the model stiffness, displacement of fractured bone fragments, titanium alloy plate, screw stress distribution, and fatigue properties of the tibia and the internal fixation system under various conditions. Results: The stiffness of the model increased significantly after internal fixation. The anteromedial plate was the most stressed, followed by the posteromedial plate. The screws at the distal end of the lateral plate, the screws at the anteromedial plate platform and the screws at the distal end of the posteromedial plate are under greater stress, but at a safe stress level. The relative displacement of the two medial condylar fracture fragments varied from 0.002-0.072mm. Fatigue damage does not occur in the internal fixation system. Fatigue injuries develop in the tibia when subjected to cyclic loading, especially when running. Conclusion: The results of this study indicate that the internal fixation system tolerates some of the body's typical actions and may sustain all or part of the weight early in the postoperative period. In other words, early rehabilitative exercise is recommended, but avoid strenuous exercise such as running.

Subsidence of All-Polyethylene Tibial Components Used in Unicondylar Knee Arthroplasty: A Cohort Study.

Unicompartmental designs and techniques have been developed to preserve bone stock and minimize soft tissue trauma. Early modern designs andtechniques have been introduced with little support in the peer-reviewed literature. From October 2002 to May 2004, 64 consecutive DePuy Preservation unicondylar knee arthroplasties (UKAs) were performed in 56 patients.Two patients died of unrelated consequences, leaving 62 UKAs for review (55 medial, 7 lateral). All procedures were performed through a quadriceps-sparing approach.All components were cemented, including an all polyethylene tibial component.Clinical and radiographic follow-up data were reviewed and analyzed. At an average follow-up of 2.5 years, six (11%)of the medial tibial components have subsided.Of these, four had moderate-to-severe pain, one did require a revision to a total knee arthroplasty (TKA), and another did stabilize. An additional two patients continued to have knee pain (one requiring conversion to TKA), leaving a total of 55 UKAs (89%) functioning well at early follow-up.Additional complications have included four deep vein thromboses, three cardiac issues following the index procedure, one surgical site infection, one intraoperative medial femoral condyle fracture, and one reoperation forloose cementfragments. This study demonstrates a high rate of subsidence for all-polyethylene tibial components used in UKA, resulting in pain and failure of the arthroplasty.Despite the less invasive approach, we found complications that are usually associated with TKA surgery as well as those unique to UKA.

Management of Distal Femur Unicondylar Fractures by Calcaneal Buttress Plating: A Prospective Interventional Study.

Unicondylar fracture of distal femur accounts for less than 1% of all femoral fractures. As conservative methods have shown substandard results, traditional surgical treatment includes open reduction and internal fixation by Herbert screws, cannulated screws, and conventional lateral locking plates. Though screw fixation has excellent results over long run, there is literature documenting the loosening and loss of articular congruency in elderly patients and in comminuted fracture patterns. Also, the traditional locking plates are precontoured to fit the lateral condyle, whereas there is no specific implant to fix the medial condylar fractures. The merit of the calcaneal plating is that it is easily moldable and can be used for either of the sides irrespective of fracture pattern. This study aimed to evaluate the clinical outcome of calcaneal plate (D-shape) fixation in distal femur unicondylar fractures. A total of 30 patients were studied, who met the inclusion criteria and consented to the surgery. After appropriate investigations, these patients were treated with calcaneal plating and were followed up postoperatively at 2 weeks, 1 month, 3 months, and 6 months for clinical evaluation. There was a gradual increase in the range of motion (ROM) with subsequent follow-ups. The overall mean ROM evaluated at 6 months was 108.46° ± 28.27° with P < 0.001 and was a statistically significant outcome. Also, the mean ROM for sagittal split fractures (~120°) was comparatively more than the coronally split fractures (~90°). The functional outcome assessed by Neer scoring showed excellent and satisfactory results in 24 (80%) patients, whereas the remaining six (20%) patients had poor results. None of the patients had nonunion, infection, or implant failure. With no specific implant for isolated unicondylar fractures, the use of calcaneal plate in our study has shown promising results probably due to its low profile design reducing the soft-tissue irritation and wide area of bone coverage by the plate offering regions of intermittent fixation due to its spanning design, thereby promoting periosteal preservation and ultimately fracture union.

Nonunion of humeral medial condyle fracture caused by excessive functional exercise: a case report and review of the literature

BackgroundMedial epicondyle fractures are one of the more common humerus fractures, but humeral medial condyle fracture (HMCF) is rare. Nonunion of medial humeral condyle fractures due to functional exercise is less common.Case presentationWe report a 5-year-old patient with a nonunion HMCF due to excessive functional exercise, who bruised the elbow 1 year ago and had no positive findings on all imaging studies. On this physical examination, there was a snapping and palpable lump in the elbow joint during movement, but the patient did not feel any discomfort and the range of motion of the joint was normal. X rays and computed tomography (CT) showed that the left HMCF was discontinuous, the broken ends were dislocated, and the joint alignment was poor. Open reduction (OR) and screw fixation was used during the operation, and the patient recovered well at 3-month follow-up.ConclusionsThe rarity and low radiographic appearance of displaced HMCF are easily overlooked and can eventually lead to nonunion HMCF, especially when radiographically difficult to visualize before age 5 years. Therefore, regardless of whether there are signs or imaging abnormalities in the growth process of adolescents, they should be vigilant, shorten the time interval for re-examination, and early detection and timely treatment can avoid some complications caused by this.

Open Reduction of Condylar Fracture Through a Modified Endaural Approach.

Throughout history, several authors have extensively modified approaches to temporomandibular joint surgery to improve access, improve aesthetics, and decrease the risk of nerve damage. In this report, we propose the reduction of a medial condylar fracture through the modified endaural approach, being a safe approach for the facial nerve, effective, aesthetic, and simple to perform.

Diagnosis and treatment of periprosthetic fracture after medial unicompartmental knee arthroplasty

Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage anteromedial osteoarthritis of the knee. Medial tibial plateau fracture or femoral condyle fracture may occur after UKA, and its treatment is very challenging. The causes leading to this complication include: surgical technique errors, such as the weakening of posterior cortical strength of the tibial platform during operation, the reduction of bone mass due to too much tibial osteotomy, and the stress concentration in the bone bed due to bad alignment of the prosthesis, etc. Prosthesis design factors, such as press-fit fixation design of cementless UKA prosthesis, and multiple nail holes fixation for tibial osteotomy guide, etc. And the morphology of tibial plateau, such as tibial platform in Asian people with narrow and small shap and medial overhanging condyles. Correct selection of patients, strict surgical principles and standardized surgical techniques are the keys to prevent periprosthetic fractures during and after medial UKA. After the diagnosis is confirmed, the treatment choice mainly depends on the fracture pattern and the stability of the prosthesis.

The Functional and Radiological Outcome of Hoffa's Fracture Treated With Cannulated Cancellous Screws.

Introduction: Distal femur AO type 33 B fractures consist of partial articular fractures subdivided into three types namely sagittal lateral condyle fracture, medial condyle fracture, and coronal split fracture. Coronal plane fractures of the distal femur are less frequent compared to sagittal plane fractures and are known as Hoffa fractures. The mechanism of injury is usually a direct anteroposterior force to the flexed and abducted knee for lateral condylar fractures and a direct impact on the medial side of the knee in flexion for a medial condylar fracture. Various approaches like lateral parapatellar for lateral condylar Hoffa's fixation, with or without posterior approach for open reduction of Hoffa's fracture with screw or buttress plate fixation, medial parapatellar approach for medial condylar Hoffa's fracture screw fixation are used.Materials and Methods: This study was conducted at R L Jalappa Hospital and Research Center attached to Sri Devaraj Urs Medical College, Kolar, India, from June 2017 to May 2020 with 17 patients as a sample size.Results: Seventeen patients with Hoffa's fracture were treated with cannulated cancellous screws with lag effect including 12 males and five females with a mean age of 31.1 years. The range of motion ranged from 120 to 135 degrees of flexion with a mean of 125.2 degrees. Three patients had extensor lag ranging from 5 to 10 degrees with an average of 6.3 degrees. Neer scores were excellent in 11, good in four, and fair in two patients. The average fracture union time for the lateral condyle was 16.4 months and for the medial condyle, it was 16.7 months.Conclusion: Restoration of articular anatomy and its congruence is of paramount importance for better surgical outcomes. Closed or open reduction and stable fixation with anteroposterior cannulated cancellous screws are essential. A good post-operative rehabilitation program is required for better outcomes.

A rare case of bilateral periprosthetic fracture of medial condyle of tibia after total knee arthroplasty

Introduction: Bilateral periprosthetic fractures of medial condyle of tibia after total knee arthroplasty are of rare incidence, as evident from previous literature. The risk factors include morbid obesity, low bone mass or osteopenia, prolonged use of corticosteroids or even trivial trauma leading to stress fractures. Case Report: We reported a case of bilateral periprosthetic fracture tibia after primary total knee arthroplasty in a patient with severe varus knees and morbid obesity. X-Ray [AP view of knee] and orthoscanograms revealed the fracture; SPECT CT showed evidence of aseptic inflammation and component loosening [Type 1B fracture; Felix Classification]. Revision arthroplasty was done with an augmented long-stem implant and the patient was discharged after a normal postoperative phase on the 10th day. Knee movement at 6 months was 0-120 degrees with satisfactory outcome scores on follow-up. Discussion: The incidence of bilateral periprosthetic fractures of tibia after primary knee arthroplasty are of rare occurrence, and often associated with severe varus malalignment and morbid obesity. Obesity leads to excessive joint overloading, and together with varus malalignment may lead to component loosening, requiring revision arthroplasty. Conclusion: Even though bilateral periprosthetic tibial fractures are rare, immediate diagnosis and treatment is necessary, if associated with varus knees and morbid obesity after primary total knee arthroplasty. Reduction of weight is mandatory before primary total knee arthroplasty to improve the functional outcomes and reduce the incidence of revision arthroplasty.

Corrective osteotomy for the management of varus deformity and malunion after medial condylar femoral fracture: a case report

Corrective osteotomy for the management of varus deformity and malunion after medial condylar femoral fracture: a case report

Risk factors of early periprosthetic femoral fracture after total knee arthroplasty

BackgroundPeriprosthetic femoral fracture (PFF) is a serious complication after total knee arthroplasty (TKA). However, the risk factors of PFF in the early postoperative setting are not well documented. This study determines the risk factors of early PFF after primary TKA.MethodsThis study recruited 24 patients who had early PFF within postoperative 3 months and 96 control patients. Demographic data (age, gender, weight, height, body mass index, Deyo-Charlson comorbidity index, diagnosis, operated side, underlying diseases and history of steroid usage intraoperative outcomes), intraoperative outcomes (operative time, surgical approach, type and brand of the prosthesis), and radiographic outcomes (distal femoral width; DFW, prosthesis-distal femoral width ratio; PDFW ratio, anatomical lateral distal femoral angle; LDFA, the change of LDFA, femoral component flexion angle; FCFA and anterior femoral notching; AFN) were recorded and compared between groups. Details of PFF, including fracture pattern, preoperative deformity, and time to PFF were also documented.ResultsIn univariate analysis, the PFF group had significantly older, right side injury, rheumatoid, dyslipidemia, Parkinson patients than the control group (p < 0.05). No cruciate-retaining design was used in PFF group (p = 0.004). Differences between the prosthetic brand used were found in this study (p = 0.049). For radiographic outcomes, PFF group had significantly lower DFW but higher PDFW ratio and postoperative LDFA than the control group (p < 0.05). While the change of LDFA, FCFA and AFN were similar between groups. The fracture patterns were medial condylar (45.8%), lateral condylar (25.0%) and supracondylar fracture (29.2%). The mean overall time to PFF was 37.2 ± 20.6 days (range 8–87 days). Preoperative deformity was significantly different among the three patterns (p < 0.05). When performed multivariate analysis using the logistic regression model, age was only an independent risk factor for early PFF. The cut-off point of age was > = 75 years, with a sensitivity of 75.0% and specificity of 78.1%.ConclusionThis study determined that age was the independent risk factors for early PFF. However, further well-controlled studies with a larger sample size were needed to address this issue.

Clinical examination of various jaw fractures and evaluation of open and closed reductions: Six case reports

Aim: This study aims to present the fracture types and treatment methods of jaw fracture cases that presented at our center.&#x0D; Methodology: Of six presenting cases, two were angulus, one was parasymphysis, three were subcondylar, and one was a medial condyle fracture only. All patients were evaluated both clinically and radiologically by CT of the atlanto-occipital joint. We managed two of the mandibular fractures with open and closed reduction (mixed) and four with closed reduction only. Dislocation was observed in only two patients. Internal fixation was performed using either mini plates (Medartis, Basel, Switzerland) or mini-screws. All cases united within three weeks to three months.&#x0D; Results: After analyzing the epidemiology of six fractures and the outcomes of the surgical treatment, as well as assessing the complications related to the surgical procedures, it was determined that in cases with dislocation, bimaxillary fixation should be applied as a maintenance to open reduction therapy. In cases without dislocation, bimaxillary fixation only is sufficient.&#x0D; Conclusion: An analysis of dislocation conditions according to fracture type supports that the incidence of dislocation is low in condyle fractures.&#x0D; Conclusion: An analysis of dislocation conditions according to fracture type supports that the incidence of dislocation is low in condyle fractures.&#x0D; &#x0D; How to cite this article: Özüdoğru S, Başaran MM, Ataözden T. Clinical examination of various jaw fractures and evaluation of open and closed reductions: Six case reports. Int Dent Res 2021;11(Suppl.1):274-8. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.40&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.&#x0D;

Анализ отдаленных результатов оперативного лечения пациентов с переломами проксимального отдела большеберцовой кости аппаратом Илизарова

Introduction Fractures of the tibial plateau are classified by the location of the fracture line, associated capsular ligamentous injuries to the knee and can result from different types of high – or low-energy mechanisms of injury in patients of any age with different bone quality. These factors are responsible for different long-term functional outcomes and the lack of a generally accepted algorithm for diagnosis and treatment. The objective of the study was to analyze the long-term functional outcomes in patients with tibial plateau fractures treated with the Ilizarov external fixation. Material and methods The review included long-term outcomes of 59 patients with tibial plateau fractures treated with the Ilizarov external fixator. Long-term results were evaluated in 53 patients out of 59 (89.83 %) using a subjective and objective clinical assessment system.The follow-up period ranged from 2 to 4 years. Patients were requested to complete the Oxford Knee Score questionnaire used in subjective outcome. Results Knee joint function of patients with tibial plateau fractures treated with the Ilizarov external fixation were rated as satisfactory (n = 34; 64.15 %); 16 (30.19 %) and 3 (5.66 %) patients were diagnosed with mild and moderate gonarthrosis, respectively. No infection that would affect the outcome was recorded in the study group. The mean Oxford Knee Score was 43.06 ± 3.44 (SD) in Schatzker type I split fractures of the lateral femoral condyle; 40.50 ± 5.57 (SD) in Schatzker type II split fractures combined with lateral articular surface depression; 40.71 ± 4.27 (SD) in Schatzker type III depression fractures; 42.33 ± 4.22 (SD) in Schatzker type IV medial condylar fractures; 38.50 ± 7.19 (SD) in Schatzker type V bicondylar fractures and 37.50 ± 5.17 (SD) in Schatzker type VI bicondylar fractures with dissociation of the metaphysis and diaphysis. Conclusions Tibial plateau fractures can be treated with the Ilizarov external fixation and also with the use of screws at any point of time that allows closed or open reduction of the fracture to ensure the early function of the operated limb, stable bone fixation, control of the fixation stiffness at any stage of treatment facilitating good and excellent functional outcomes.

Ultrasound-guided closed reduction and kirschner wires internal fixation for the treatment of KilfoyleⅡand Ⅲ medial condylar fracture of humerus in children

To explore clinical effectiveness and safety of ultrasound-guided closed reduction and K-wires internal fixation in treating of Kilfoyle Ⅱand Ⅲ medial condylar fracture of humerus in children. Clinical data of 32 children with medial condylar fracture of humerus treated with closed reduction and internal fixation with K-wires under the guidance of ultrasound were retrospectively analyzed from January 2014 to August 2019, including 23 males and 9 females, age ranged from 3.2 to 12.8 years old with an average of (8.3±2.1) years old;According to classification of Kilfoyle, 12 patients classified to typeⅡ and 20 patients were type Ⅲ;5 patients combined with elbow dislocation;the time from injury to operation ranged from 1 to 5 days with an average of (3.1±1.3) days. Radiological evaluation of treatment results and complications were observed. At the final follow up, Mayo elbow performance score(MEPS) was used to evaluate elbow function. And humerus-ulna angle on the affect side and healthy side were measured and compared. All patients were followed up from 8 to 26 months with an average of(19.3±5.5) months. All fractures were healed well, the healing time ranged from 4 to 6 weeks with an average of (4.5±0.5) weeks. No infection, vascular and nerve injury, bone nonunion, trochlear necrosis, cubitus varus or valgus deformity were occurred. According to Mayo scoring, all patients were assessed as excellent. There was no significant difference in angle of humerus-ulna between affectedside (9.5±3.6)° and healthy side (9.1±3.5)°, and no difference in MEPS scores between affected side(95.3±2.5) and healthy side(96.3±2.2)(P>0.05). For Kilfoyle typeⅡand Ⅲ medial condylar fracture of humerus in children, closed reduction and internal fixation with K-wire under ultrasound guidance is a safe and effective method, and could promote in further.

A novel universal medial approach for difficult posteromedial tibial plateau fractures: a prospective case series

Background: Tibial plateau fractures are considered to be one of the most common fractures with an increasing incidence of motor vehicle accidents. Posteromedial fracture, in particular, is considered a more challenging case. Combination of posteromedial fragment fracture with central articular depression or medial condyle fracture make it much more difficult to reduce and adequately fix the fractured fragments. The aims of this study were to describe a new extensile medial approach for the management of different types of tibial plateau fractures with posteromedial fragments and to evaluate results using this approach. Methods: Between January 2015 and January 2017, 15 patients with Schatzker IV, V, or VI fractures, in combination with a posteromedial fragment, were operated for open reduction of the fracture with restoration of the articular surface alignment. Fixation was done by double plate osteosynthesis. Complete healing time and knee-function scores were recorded in the follow-up period. Results: The average age of patients was 41.8 yr; the mean follow-up period was 30 mo. One patient had superficial wound dehiscence and was treated conservatively. No patients with knee instability or loss of reduction were reported. Conclusions: The posteromedial approach offers a very good access to view, reduce, and fix difficult posteromedial fractures together with comminuted tibial plateau fractures without the need for dissection of the neurovascular bundle in the fossa or soft-tissue injury. Level of Evidence: Level IV.

Trash Lesions Around the Elbow: A Review of Approach to Diagnosis and Management.

TRASH lesions are a group of special injuries around the elbow resulting from high energy trauma that are routinely missed at initial presentation because of seemingly normal X-rays. These are a group of osteochondral injuries having a high propensity for surgical intervention and usually have poor outcomes if not treated adequately. Prompt diagnosis warrants a high index of suspicion even when a radiograph appears to be normal with a disproportionately swollen elbow in a child. TRASH lesions include radial head osteochondral fractures, medial condylar fractures in unossified elbow, transphyseal separations of the distal humerus, monteggia lesions, entrapped incarcerated medial epicondylar fractures, capitellar shear fractures, lateral condylar fractures extending to the cartilage. This article attempts to review in brief, the approach to early diagnosis and management with literature review and case examples.

Functional outcome of proximal tibia treated fractures of medial condyle with posteromedial locking compression plate

Background: Tibial plateau fractures are a challenge, although they have widespread incidence since they are often associated with soft tissue lesions. They are typically caused by high-speed injuries and in young age groups, they become a severe socio-economic burden for the family. Objective: Evaluation of the clinical outcome of patients with proximal tibial plateau fractures, in particular medial condyle fractures, treated with posteromedial lock compression plate. Methods: Patients meeting the inclusion criteria were chosen and a full comprehensive history and clinical review were collected to determine associated soft tissue fractures, neurovascular disorders and compartment syndrome. The scientifically suspected pathology was confirmed by x-rays and MRI scans. Using the Schatzker classification, all Tibial condyle fractures were classified preoperatively. The patients underwent postoperative follow-up after a period of six months after surgery. The patients who had completed the inclusion criteria were evaluated to use the Rasmuseen score and knee society score to determine the functional outcome of the knee.Results: Male predominance was observed with males being 80% and females were 20%. The male: female ratio was 4:1. Majority of the patients around 36% belonged to the age group of 21 to 30 yrs. The mean age was (mean + SD) 40.5 + 11.69 yrs. By Schatzker classification of fractures of tibial plateau, the majority around 48% had Type IV fracture, 32% had Type V and 20% had Type VI fracture. In Majority of the cases after successful surgery around 68% had no complications, In 12% of the cases they had superficial infections and in another 12% of the cases they had knee pain post op. Knee stiffness was seen in 8% of the cases. Conclusion: Posteromedial tibia fixation helps early healing of the patient and has an outstanding functioning outcome with reduced incidence of complications. The well-planned approach to tibial plateau fracture with importance to the posteromedial fragment has impressive functional outcomes.