Medial Condyle Fracture Research Articles

A Case of a Yorkshire Terrier with Medial Condylar Fracture of the Humerus Caused by Incomplete Ossification of the Humeral Condyle

A Case of a Yorkshire Terrier with Medial Condylar Fracture of the Humerus Caused by Incomplete Ossification of the Humeral Condyle

A comparative study based on surgical and functional outcome of proximal tibia fractures between unicondylar and bicondylar fractures

Background: Tibia plateau fractures constitute 1%of all fractures. Bicondylar fractures account for 10-30%, whereas isolated medial and lateral condyle fractures constitute the remaining injuries. Although only 3% of these fractures are open injuries, many of them have closed degloving, deep abrasions or severe soft tissue injuries which require careful consideration in deciding the timing and the nature of surgery. Proximal tibia fractures may be difficult to treat even in experienced hands due to intraarticular extension, comminution, cartilage damage and soft tissue injuries of the cruciate ligaments and menisci. Aim: To compare the functional and surgical outcomes of operative treatment of unicondylar and bicondylar fractures. Materials and Methods: It was a prospective and comparative study of Surgical and functional outcome of proximal tibial fractures in the department of orthopaedics from July 2019 to December 2019. Clearance was obtained from the hospital ethical committee. Fifty patients were taken into consideration for the study. All patients are selected on the basis of history, clinical examination and radiography. The Schatzker’s classification was used to classify these fractures. The patients were followed up for an average period of 6 to 12 months. The patients were divided into two groups. Twenty-five patients in the unicondylar fracture group 1and 25 patients in the bicondylar fracture group 2. Results: The mean age of group 1 patients was 45.7210.85 years, and that of group 2 patients was 46.408.602 years (p>0.05). In group 1 there were 18 (72%) males and 7 (28%) females, in group 2 there were 21 (84%) males and 4 (16%) females. In group 1, the mean union time was 3.04 0.351 and in group 2 was 3.1 0.433(p>0.05). In group 1, the mean follow-up time was 12.81 2.09 and in group 2 was 13.04 2.28 (p>0.05). The mean functional score of group 1 was 91.212.27, and in group 2, it was 8718.2 (p>0.050). In group1 mean WOMAC score was

Functional outcome of tibial condylar fractures (Schatzker type V, VI) managed surgically with mippo technique

Introduction: Fractures involving proximal tibia & extending into the knee joint, are known as tibial plateau fractures. They comprise of 1% of all fractures and 8% of the fractures in elderly. Lateral condyle fractures are most common (55-70%). Medial condyle fractures (10 to 23%), bicondylar fractures (10-30%). Most common mechanism of injury is direct axial compression, with a valgus or varus moment and indirect sheer forces. AIM: This study was conducted to observe the functional outcome of surgical management in schatzker type V, VI tibial plateau fractures with proximal locking compression plate. Materials and Methods: 30 cases of Schatzker type V and VI Tibial plateau fractures were taken up for this prospective study. Patients were followed up for a minimum period of 6 months. First follow up was at 6th week, and second follow up was done at 3 months. Both radiological and clinical evaluation was done at both the times. The anatomic and functional evaluation was done using the modified Rasmussen clinical and radiological criteria. Results: In our study, we found that most cases were between 5th-6th decade. Males were affected more than females (80% & 20%). Majority of the patients showed involvement of right tibia (21/30), as compared to left (9/30). RTA was the most common mode of injury, accounting to 77% of the cases followed by self-fall-23%. Conclusion: MIPPO (minimally invasive percutaneous plate osteosynthesis) technique minimizes the size of the surgical incision and avoids soft tissue injury, in turn reducing post-operative complications, leading to better wound healing.

Secondary osteoarthritis of the knee due to 40-year nonunion of a medial femoral condyle fracture: A case with good outcome without arthroplasty

Isolated femoral condyle fracture is an uncommon entity. It accounts for only 0.65% of all femoral fractures, with lateral condyle involvement three times more frequently than the medial condyle. In neglected cases, nonunion and malalignment may occur, which results in osteoarthritis of the knee due to uneven distribution of load across respective compartments. In treating such cases, both osteoarthritis and nonunion have to be tackled to reconstruct a stable, mobile, pain-free, and well-aligned knee joint. There are a number of surgical options, including excision of the nonunion fragment, fixation of the nonunion fragment with or without bone graft, and total knee arthroplasty with or without stem extension. In the following, we present a case of 40-year non union of the lateral condyle and our rationale of management for a relatively young lady. During the course of treatment, there was an unexpected success even though arthroplasty was not performed. A management strategy for this challenging condition was also suggested.

Management of proximal tibial fractures by posteromedial locking compression plate

Management of tibial plateau fractures aims to restore normal knee functionality by near normal anatomical restoration of the articulating surfaces, thereby maintaining the mechanical axis and restoring ligamentous stability. Plate fixation is important when a medial plateau is involved in proximal tibial fractures. The present study was designed to assess the management of medial condylar fractures of proximal tibia treated by posteromedial locking compression plate. A total of 30 cases with Schatzker type IV-VI fractures to the proximal tibia, who followed up for clinic radiological evaluation, between age group 20-60 years were recruited. Clinical examination and radiological investigations were performed to review the fractures. The fractures to the medial condyle of tibia were treated by posteromedial approach. Post-operative care has been initiated with physical therapy in the form of quadriceps exercises. The postoperative follow up was continued at the end of one month, three months and six months and outcomes were recorded by using Lysholm knee score. According to Schatzker type of fractures 46.6% had type IV, 33.3% had type V and 20% had type VI fractures. Majority cases had fractures due to road traffic accidents (70%). Postoperative fracture outcome showed excellent outcome in 78% cases, good results in 16%, fair results in 6% and none of the case had a poor outcome. In postoperative complications, 80% cases were recovered without complications, 10% cases had superficial infection, 7% cases had knee pain, and 3% cases had knee stiffness. The posteromedial approach of tibial fracture management is safe with minimal complications. Fixation of posteromedial tibia permits quick reformation of the patient with outstanding functional outcome with minimal incidence of complication.

Management of nonunion of humeral medial condyle fracture: A case series and review of the literature

Pediatric humeral medial condyle fracture (HMCF) is a rare condition and is difficult to detect, especially in young children. The management of late presentation of HMCF is challenging and lacks consensus. Herein, we reported four cases of HMCF nonunion received open reduction and internal fixation (ORIF) or supracondyle osteotomy from our institution. In addition, 12 cases of ORIF and 4 cases of osteotomy reported in the previous studies were also reviewed. The HMCF nonunion can heal after ORIF, but the indication and the optimal techniques need to be clarified. Supracondylar osteotomy alone is an effective and safe treatment option to improve the functional and cosmetic outcomes of HMCF nonunion.

Effect of breed as a risk factor for humeral condylar fracture in skeletally immature dogs.

To investigate the effect of breed as a risk factor associated with humeral condylar fracture in skeletally immature dogs in the UK. Retrospective study of dogs under 12 months of age that were presented with humeral condylar fracture to three specialist referral centres between 2015 and 2018. Data retrieved from medical records included breed, age, gender, neuter status, affected limb, fracture configuration and aetiology of the fracture. Breed population percentages were compared with those recorded by the UK Kennel Club. Of the 115 dogs with 118 fractures, French bulldogs (41%) and English springer spaniels (15%) were overrepresented: humeral condylar fractures were more commonly diagnosed in French bulldogs (odds ratio=5.86) and English springer spaniels (odds ratio=5.66) compared with mixed-breed dogs. Lateral condylar fractures occurred in 70% of cases, with medial condylar fractures and Y/T fractures accounting for 9% and 21%, respectively. Median age at the time of fracture was 4months (range 2 to 10months). French bulldogs and English springer spaniels were identified as being at potentially increased risk of humeral condylar fracture in skeletally immature dogs.

Characteristics of medial condyle sagittal fracture of distal femur involving intercondylar notch in geriatric patients.

Unicondylar femoral fractures are uncommon injuries, known to occur primarily in young people, with high energy trauma. However, according to our experiences, unicondylar femoral fractures in geriatric patients generally involved the medial femoral condyle, unlike previously reported. In addition, the fractures of medial femoral condyle (FMFC) showed a characteristic fracture pattern. To date, there has been no published article focusing on the FMFC in geriatric patients. Thus, the aim of this study was to determine the characteristics of FMFC in geriatric patients and to present their outcomes. We retrospectively reviewed the medical records of 13 patients over age of 65 who underwent surgery for FMFC (AO-OTA 33B2). Of the 13, 10 patients were treated with Tomofix medial distal femoral plate (MDF) (Synthes GmbH, Switzerland) and additional screws fixation; the other three were treated with screw fixation and cast application. The mean age of patients was 76.8years, and 10 patients were females. The fracture was due to low-energy trauma in all of the cases. Eight patients had medial knee osteoarthritis, and 2 patients were on osteoporosis treatment. A characteristic fracture pattern was observed. The fracture line extended from the lateral aspect of the intercondylar notch to the posteromedial column of the distal femur, with a characteristic medial beak. All fractures belonged to AO classification 33B2.1; there were no cases of AO classification 33B2.2 or 33B2.3. The postoperative joint function was graded according to the Kolmert functional criteria: ten cases were excellent, one case was good, one case was fair, and one case was poor. FMFC caused by low-energy trauma in geriatric patients tend to have a characteristic pattern. We believe that anatomic reduction and firm fixation with Tomofix MDF plate and cannulated screw for low-energy trauma FMFC in geriatric patients would yield good outcomes.

Racing performance after surgical repair of medial condylar fracture of the third metacarpal/metatarsal bone in thoroughbred racehorses.

To report the performance of thoroughbred racehorses after surgical repair of a medial condylar fracture of the third metacarpal/metatarsal bone. Retrospective cohort study. Forty-three horses surgically treated for medial condylar fractures, 30 with previous racing experience, 13 without previous racing experience (nonexperienced). Medical records (2009-2017) were reviewed for signalment, radiographic fracture characteristics, repair technique, and postoperative morbidity and mortality. Each experienced horse was matched with two horses randomly selected from its most recent race to serve as healthy controls. Racing performance parameters (race rating, competitive level, speed rating, performance index) and career racing statistics were compared with multiple regression models between injured experienced horses and controls. The career racing statistics for nonexperienced horses were evaluated. Reasons for nonreturn to racing were obtained. The median duration of follow-up was 6 years (minimum 2, maximum 10). Twenty-one of 43 (49%) horses raced again as well as 18 of 30 (60%) experienced horses and three of 13 (23%) nonexperienced horses. Experienced horses were five times more likely than nonexperienced horses to return to racing (95% confidence interval = 0.07-0.58, P = .003). Higher preoperative racing performance parameters were associated with return to racing. Racing performance parameters were lower after the date of fracture in injured horses compared with controls. Experienced horses were more likely to return to racing after medial condylar fracture repair, although their performance was generally lower than that of comparably uninjured horses. Owners should be aware that horses with medial condylar fractures likely will race at a lower level than their uninjured peers.

Primary intra-articular osteotomy for varus malunion of the medial condyle of the tibial plateau

<p class="abstract"><strong>Background:</strong> Reconstructive operative procedures for post-traumatic deformities of the tibial plateau have been described in literature, though rarely. We report short term follow-up of eleven such cases of primary intra-articular osteotomy.</p><p class="abstract"><strong>Methods:</strong> From 2005 through 2011, a primary intra-articular osteotomy for varus malunion of the medial condyle of the tibial plateau was performed in eleven consecutive cases. The patients were assessed clinically and radiologically at a minimum of 28 months post-operatively. The functional outcome was assessed using Rasmussen score. Paired ‘t’ test was used to determine the statistical significance.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were eleven male patients. Average follow up was 59 months (range 28 to 159). Articular congruity was restored to acceptable in all patients and varus malalignment was corrected from a mean of 1.5 degrees varus to 5.7 degrees of valgus (statistically significant, two-tailed P value of 0.0056) to an extent comparable to the normal side (mean 5.8 degrees). There were no infections. All patients had good to excellent functional outcome.</p><p class="abstract"><strong>Conclusions:</strong> A primary intra-articular osteotomy and osteosynthesis for malunited medial condyle fracture of the tibial plateau would help to restore mechanical alignment and improve functional outcome.</p>

Use of MRI assisting the diagnosis of pediatric medial condyle fractures of the distal humerus.

The aim of this study was to describe the radiographic appearance and to evaluate the elbow function with the Mayo elbow performance score (MEPS) in children with medial condyle fracture of the distal humerus (MCFH) who were treated surgically. During the period of 2011–2017, a total of 10 patients (three boys, seven girls) were retrospectively reviewed after obtaining institutional review board approval. All patients underwent open reduction and percutaneous pinning fixation. The average age at the time of injury was 7.7 years (range: 4.0–12.5 years), and the mean follow up was 43.9 months (range: 8.1–67.1 months). The clinical and radiographic outcomes of medial condyle fracture were retrospectively evaluated. Among 10 patients, half were diagnosed with MCFH initially by the radiograph, four out of 10 patients had their diagnosis confirmed with the aid of MRI, and an intraoperative diagnosis was made in only one individual. The average humeral-ulnar angles of the injured and noninjured sides were 9.7° ± 5.3° and 9.3° ± 4.7°, respectively (P = 0.679). The average MEPSs of the injured and noninjured sides were 95.5 ± 2.8 and 96.5 ± 2.4 points, respectively (P = 0.168). In this retrospectively evaluated cohort submitted to surgical management of medial condyle fracture of the distal humerus, MRI has been proven beneficial assisting the diagnosis and allowing effective joint restoration with mid-term good functional outcome.

Case Report of a Medial Femoral Condyle Fracture in a Unicompartmental Oxford Knee Replacement Surgery

Introduction: The unicompartmental Oxford prosthesis has been used as a goodalternative for medial unicompartmental osteoarthritis because it is associated with earlyrehabilitation and a low rate of intraoperative complications. This case describes a rarecomplication during the procedure. Case Presentation: We present an intraoperative fracture of the medial condyle in a 70-year-old woman that was treated with 6.5 mm cannulated screws with a compressiontechnique. The patient remained in a non-weight bearing protocol for 6 weeks andreached a full range of mobility at 3 months. Complete radiological consolidation and agood functional outcome were observed. Conclusion: Intraoperative fractures benefit from a stable osteosynthesis that allows freerange of mobility and does not delay postoperative rehabilitation.

Retrospective analysis of 514 cases of tibial plateau fractures based on morphology and injury mechanism

BackgroundTibial plateau fractures remain a clinical challenge due to the complexity of the fracture patterns which have been repeatedly categorized by many researchers. However, limitations do exist in some respects. So we aimed to reclassify tibial plateau fractures based on injury mechanism and morphological characteristics.MethodsFive hundred fourteen cases of tibial plateau fractures were enrolled. The X-rays and CT scans were analyzed.ResultsAccording to our observation and analysis, tibial plateau fractures can be categorized into the following six types: (1) Lateral condylar fractures (axial force applied while knee extending in valgus position). Two hundred fifty-one cases were included (48.83%). (2) Fracture dislocation (multiple forces especially rotational stress while knee extending). Fifty-five out of 514 cases belong to this pattern (10.70%). Correction of the subluxation remains primary and crucial during surgical procedures. (3) Simple medial condylar fractures (axial force applied while knee extending in varus position). One third of which were associated with an avulsion fracture of fibular head. Fifteen cases were included (2.92%). (4) Bicondylar fractures (axial forces applied while knee extending). One hundred twelve cases were included (21.79%). Surgical algorithm greatly depends on soft tissue conditions. (5) Posterior condylar fractures (axial stress applied while knee flexing). Sixty-five cases were seen in our study (12.65%), most of which were associated with an avulsion fracture of the intercondylar eminence (49/65, 75.38%). The fracture of posteromedial part, posterolateral part, and intercondylar eminence forms a unique pattern of injury defined as “Posterior Condylar Triad.” (6) Anterior condylar compression fractures (axial, varus, or valgus forces applied while knee overextending). Posterior structural complexes, crucial ligaments, or even popliteal arteries are prone to be damaged. Sixteen cases were identified (3.11%).ConclusionOur classification system has instructive significance in overall preoperative evaluation of fracture features and soft tissue problems as well as guiding clinical management for better functional outcomes.

Neglected anterior monteggia lesion with a displaced intra-articular medial condyle fracture in a child: A rare and challenging association

Monteggia fracture dislocation refers to a dislocation of the proximal radioulnar joint together with an ulnar fracture. Bado described four types of Monteggia lesions. Type I is the most common, where the radial head is dislocated anteriorly. Misdiagnosis of pediatric Monteggia fracture dislocations is fraught with potentially serious functional complications and treatment challenges. This is especially true in the event of late presentation and association with a simultaneous ipsilateral skeletal comorbidity. We present the case of a child with an extremely rare neglected type I Monteggia fracture dislocation associated with a displaced intra-articular medial humeral condyle fracture. We aim to demonstrate the radioclinical outcome of surgical management of this child and to offer possible mechanisms of injury found upon fracture characteristics and biomechanics. The patient was managed by a characteristic open surgical technique that offered satisfactory functional and radiologic outcomes on the short-term despite late presentation. We established correlations between the proposed injury mechanism, imaging abnormalities, and intraoperative findings that aided in management implementation.

Cortical Perforation Misidentified with Medial Condylar Fracture of Femur in Total Knee Arthroplasty: Case Report

Cortical Perforation Misidentified with Medial Condylar Fracture of Femur in Total Knee Arthroplasty: Case Report

Fractures of femoral medial condyle treated with contralateral less invasive stabilization system through a medial-posterior approach

Objective To investigate the therapeutic efficacy of contralateral less invasive stabilization system (LISS) through a medial-posterior approach for fractures of femoral medial condyle. Methods From December 2010 to December 2014, 14 patients with fracture of femoral medial condyle were treated surgically at our department. They were 10 males and 4 females, aged from 33 to 64 years (average, 44.6 years). By AO classification, 10 cases were type 33-B2 and 4 cases type 33-B3. Causes of injury included traffic accident in 7 cases, falling in 6 and heavy object crush in one. Internals from injury to operation ranged from 3 to 10 days (average, 5.4 days). All the patients were treated by open reduction and internal fixation with contralateral LISS plate or T plate through a knee medial posterior approach. Results The 14 patients were followed up for 12 to 24 months (average, 18 months). All fractures got bony healing after 3 to 5 months (average, 3.5 months). No collapse of joint surface, joint stiffness, joint infection, malunion or nonunion occurred. According to the Schatzker-Lambert criteria for functional recovery of the distal femoral fractures, the function of the affected knee was assessed at the last follow-up as excellent in 9 cases, good in 3, fair in one and poor in one. Conclusion Open reduction and internal fixation with contralateral LISS plate through a medial-posterior approach is effective for fractures of femoral medial condyle due to its strong buttress, rigid fixation, advantage for early functional exercise, and satisfactory therapeutic outcome. Key words: Femoral fractures; Fracture fixation, internal; Bone plates; Posterior median approach

Medial humeral condyle fracture in childhood: a rare but often overlooked injury

The medial condyle fracture of the humerus is-in comparison to the lateral condyle fracture-a very rare Salter-Harrison IV-fracture of the elbow. In this prospective study 14 children were included and reviewed. One child had minimal displacement fracture type I, one child had type II, and 12 children had type III-fractures. One patient was treated conservatively by an upper arm cast; thirteen were surgically treated using open reduction and osteosynthetical treatment. Postoperatively the elbow was immobilized in 90° flexion and neutral position in a long-arm cast for 4-6weeks. In 11 children the diagnosis was made immediately after trauma, in 3 children the fracture was overlooked initially. Medial condyle fractures may be difficult to diagnose in children younger than 6years and the lesion may be mistaken for a simple avulsion of the medial epicondyle or even missed. The C-sign is a hint for a medial condyle fracture. The development of nonunion happens in consequence of failure to recognize the fractures. Results after an average follow-up of 36months showed that children who were diagnosed immediately and received operative stabilization had very good functional and aesthetical results. Three children with delayed diagnosis of the fracture had open surgery with reposition and osteosynthetical fixation. In two of the overlooked cases a slight contracture and angular misalignment persisted. If in this injury the diagnosis is made without delay, an appropriate therapy is implemented and radiographical controls are performed until consolidation, good results can be expected. The main risk in medial condyle fractures of the humerus is to overlook them. This can lead to the development of a nonunion with joint malformations.

Effectiveness analysis of surgical treatment of Schatzker type Ⅳ tibial plateau fractures

To introduce a surgical protocol based on the location and orientation of the apex of the medial condylar fracture line for the treatment of Schatzker type Ⅳ tibial plateau fractures and report the preliminary effectiveness. The clinical data of 18 patients with Schatzker type Ⅳ tibial plateau fractures underwent open reduction and internal fixation between March 2012 and April 2016 were retrospectively analysed. There were 6 males and 12 females, aged 36-74 years (mean, 45 years). The causes of injury included traffic accident in 2 cases, falling in 14 cases, bruise injury in 1 case, and crush injury of heavy object in 1 case. All cases were fresh closed fractures, without injury of nerves and blood vessels. According to sub type of Wahlquist tibial plateau type Ⅳ fracture classification, there were 1 case of type A, 5 cases of type B, and 12 cases of type C. The interval of injury and operation was 6-16 days (mean, 9.5 days). The location of the apex of the medial condylar fracture line was determined the surgical approach. After operation, reduction of tibial plateau fractures was evaluated by the DeCoster score evaluation criteria. The knee joint function was assessed by short Musculoskeletal Function Assessment (SMFA) score and Hospital for Special Surgery (HSS) score. The incisions all healed by first intension after operation without surgery related complications. All the patients obtained satisfactory exposure and reduction during operation. According to DeCoster score evaluation criteria, the results were excellent in 13 cases and fair in 5 cases. All the patients were followed up 12-30 months (mean, 18 months). X-ray films showed that all fractures healed at 10-16 weeks (mean, 12 weeks) after operation. There was no plate displacement, screw loosening, and other complications occurred during follow-up. At last follow-up, the SMFA score was 15-48 (mean, 28.5). The HSS score was 52-94 (mean, 81.1), and the results were excellent in 10 cases, good in 5 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 83.3%; the main clinical manifestation was severe traumatic osteoarthritis symptom in 1 case with the fair result. The surgical program should be developed based on the location and orientation of the apex of the medial condylar fracture line. Open reduction and internal fixation for treating Schatzker type Ⅳ fractures can achieve satisfactory effectiveness.

Damage control orthopaedics

Emergency procedures aimed at rapid reduction and fixation and spanning of periarticular fractures has been termed “damage control orthopaedics”. In severely injured patients, early definitive fixation of fractures may not be appropriate. Recent studies showed that in multiple trauma, DCO is the best option for management of patients who are unstable and in extremis. The paper presents a case of such a control in a 34-year-old patient who sustained polytrauma on 20.10.2016. Primary medical care was conducted at a local hospital. Ten hours after the injury, the patient was transported to the Bari-Ilizarov orthopaedic centre for further management. On admission, he was in a traumatic shock. Radiographic study showed a comminuted fracture of the left femur, medial condylar fracture of the ipsilateral femur, comminuted fractures of both bones of the shin, left wrist sprain, and contusion of the head. Osteosynthesis of the left femoral shaft was performed with a Kuntscher nail and additionally with the Ilizarov fixator. When patient’s condition stabilized on the next day, osteosynthesis of the tibia was performed with the Ilizarov apparatus and the wrist was fixed with a plaster cast.

Open Reduction and Internal Fixation for Humeral Medial Condyle Fracture of the Elbow in Elderly Patients with Mutilating Rheumatoid Arthritis: A report of two cases

Open Reduction and Internal Fixation for Humeral Medial Condyle Fracture of the Elbow in Elderly Patients with Mutilating Rheumatoid Arthritis: A report of two cases