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Double line signs of intramedullary infarcts on T2W MR images:

Tibial condyle

The medial and lateral condyles of the tibia, the intercondylar process, and the tibial tuberosity are located on the proximal side of the tibia.

Hans Garten MD DIBAK DACNB DO (DAAO) FACFN, in The Muscle Test Handbook, 2013.

Origin:

Semitendinosus and semimembranosus: Through a common tendon with the biceps femoris at the level of the ischial tuberosity.

Biceps femoris (long head): sciatic tubercle and sacroiliac ligament.

Biceps femoris (short head): Lateral lip of the linea aspera of the thigh.

Incision:

Semimembranous: On the medial condyle of the tibia, but also with three fibrous processes. A fiber strand reinforces the joint capsule of the knee from behind and runs vertically and laterally. The second strand of fibers runs over the popliteal muscle and encircles it to end at the line of the m. solei, and the third connects to the fibers of the medial collateral ligament and fascia.

Semitendinosus: It is the most posterior tendon and, together with the tendons of the semimembranosus, the sartorius and the gracilis, forms the pes anserinus. All tendons of the pes anserinus have a common insertion on the medial surface of the tibia.

Biceps femoris muscle: Lateral condyle of the tibia and lateral part of the head of the fibula.

Fractures and dislocations of the knee

29 What are the general types of fractures of the proximal end of the tibia?

Extra-articular fractures – tibial spine, tibia and patellar roll

Articular fractures – condylar, bicondylar and crush fractures

30 What types of condylar fractures are common in older people?

Nondisplaced fractures of the medial condyle of the tibia are common in the elderly. A varus deformity on examination usually indicates a crushed or split fracture (more common).

31 What injuries are associated with condylar fractures?

Meniscus injuries occur in up to 50 % of all condylar fractures, ligament injuries in 30 %. Neurapraxia of the cervical nerve and injury to the popliteal artery are additional associated injuries.

32 Which tibial condyle is fractured more often? Why?

The lateral condyle is more commonly fractured due to weaker trabeculation, valgus alignment of the knee, and external forces directed at the valgus 70 % to 80 %.

33 Describe the conservative treatment of nondisplaced condylar fractures.

Early passive exercises to maintain mobility and strength without strain; Only bear weight after the fracture has healed (6-12 weeks).

Immobilization in a non-weight-bearing cast (long-foot cast, 5 degrees of flexion) for 3 to 6 weeks, followed by 2 to 4 weeks of non-weight-bearing rehabilitation, with gradual weight-bearing from weeks 9 to 16.

Traction with passive movement for 6 weeks, then no weight-bearing for about 12 weeks; Return to full weight bearing when tissue healing is visible

Cast with initial non-weight-bearing and gradual weight-bearing for up to 12 weeks; full load after the tissue has healed.

34 Describe the results of low-profile, minimally invasive fracture fixation of the proximal tibia.

Approximately 91 % of these fractures heal without major complications, 10 % experience some deformity, 5 % require hardware removal, and 4 % experience infection. The average final range of motion is approximately 1 to 122 degrees, and full weight-bearing is possible an average of 12.6 weeks post-surgery.

Symptoms and diagnosis of tibial condyle fractures

Acute pain in the knee at the time of injury. The knee is enlarged and there is a varus or valgus deformity on the inner condyle and a valgus deformity on the outer condyle. Mobility and support are severely limited. The mobility of the lateral movements of the joint is abnormal. Gentle pressure with a finger on the condyle can usually clearly identify the area where the pain is greatest. There is marked hemarthrosis, sometimes leading to acute enlargement of the joint and impairment of local blood flow.

The main method of instrumental diagnosis is X-ray examination X-ray of the knee joint is the most important diagnostic tool. The x-rays are taken in two projections. In the vast majority of cases, not only the presence of a fracture, but also the type of fracture displacement can be reliably determined. If the radiological examination is not conclusive, the patient becomes one CT scan of the joint. If there is suspicion of accompanying soft tissue damage (ligaments or meniscus), a MRI scan of the knee joint. Sometimes condylar fractures are accompanied by nerve and vascular compression. If neurovascular damage (vascular and nerve damage) is suspected, a vascular surgeon and a neurosurgeon are consulted.

Treatment of fractures of the tibial head

Treatment takes place in the trauma ward. Upon admission, the trauma surgeon punctures the knee joint and injects Novocaine to numb the fracture. Further tactics depend on the characteristics of the injury. For incomplete fractures, fractures and marginal fractures without dislocation, a cast is applied for 6-8 weeks, crutches are prescribed and the patient is referred for UHF and physiotherapy. After immobilization is completed, the patient is advised to continue using crutches and not to bear weight on the limb for 3 months after the injury.

For fractures with displacement, depending on the type of fracture, a one-stage manual reduction with subsequent traction or traction without prior reduction is performed. If the fracture is only slightly displaced, adhesive traction can be used. Skeletal traction is used for fractures of one or both condyles with significant displacement or for fractures of one condyle with subluxation or dislocation of the other condyle. Traction is usually maintained for 6 weeks, during which time physical therapy is performed. After that, traction is removed and the patient is instructed to walk on crutches without putting any weight on the leg. Metatarsal fractures are characterized by delayed healing, allowing light weight-bearing after 2 months and full weight-bearing after 4-6 months.

Indications for surgical intervention include failed attempts at fracture reduction, severe compression of the fracture, impingement of the fracture in the joint cavity, vascular or nerve compression, and intercondylar process fracture with displacement with unsuccessful closed reduction. Since skeletal traction is unable to achieve ideal fracture separation in most cases, the list of indications for surgical intervention is growing, and trauma surgeons are increasingly offering the operation not only for the above injuries, but also for all condylar fractures with a significant shift.

How is it diagnosed?

General and biochemical blood tests are performed for differential diagnosis with other musculoskeletal pathologies.

X-rays are not very informative in the early stages of kneecap necrosis. Changes on X-ray images: increased bone density, microfractures, narrowing of the joint stroma only appear in the final stages of aseptic necrosis.

MRI shows structural disorganization, increased bone density and minimal necrosis in aseptic necrosis of the knee joint without any clinical signs.

Scintigraphy is recommended for the differential diagnosis of grade 3 knee joint necrosis with tumor.

The symptoms are characteristic of trauma

Symptoms appear almost immediately after the fracture and help determine the type and severity of the injury

• Appearance of a characteristic pain syndrome localized to the joint and hip;
• Instability, excessive mobility of the kneecap;
• a feeling of instability, wobbling in the knee;
• When palpated, pressure on the fractured condyle of the knee joint causes severe, stabbing pain
• Restriction of movement and severe muscle soreness in the joint;
• A grinding or cracking sound on palpation is characteristic, which is due to the presence of mobile bone fragments;
• Swelling and swelling around the knee and discharge in the joint cavity, causing the joint to flatten.

Often, patients can move independently despite a fracture and do not immediately seek medical attention because the knee does not hurt after the injury or fracture.

Important: If a fracture is suspected and symptoms from before the injury are present, you should seek medical attention immediately as sometimes there is no pain. Failure to seek medical attention in a timely manner may require surgical intervention, which can be avoided if the fracture is recent.

The doctor will determine the severity of the fracture and further treatment based on the physical examination and X-ray findings in the corresponding prognosis.

Treatment

The treatment process differs fundamentally between patients with a displaced and a non-displaced fracture.

The first step in treating a nondisplaced fracture is a puncture to remove exudate and blood in the joint cavity. A small amount of novocaine solution is then injected into the joint cavity and the joint is immobilized with a plaster cast. After the knee joint is flexed by 5-10 degrees, the limb is immobilized with a plaster cast.

The cast is applied for about 2-3 months, after which physical therapy should be carried out as part of rehabilitation. During the rehabilitation period, it is important to start training the hip muscles. This happens just 2-3 days after the plaster is applied by elevating the limb. Later, after about 7-10 days, you can use crutches, but it is important not to put any strain on the joint.

Treatment measures for fractures with displaced bone fragments may be different, but initially reduction is required, during which the displaced structures are returned to their normal anatomical position:

1. After determining the severity and type of fracture, the specialist performs a manual reduction under anesthesia, immobilizing the upper extremity while manipulating the lower extremity. An immobilizing plaster cast is then applied for the required period of time.
2. If the fracture is displaced by more than 3 mm, the doctor may also opt for treatment with fixed traction. The fracture is slowly reduced by applying a special splint and using a weight-relief system. After a few weeks, if the reduction is successful, the traction system is replaced with a plaster cast.

If the conservative method does not bring the desired result or the fracture is very complex, surgery is indicated. Displaced fractures are twisted during the operation, and the anastomosis also takes a lot of time, after which the screws are removed.

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Symptoms of a fracture of the humeral head

There is a sharp pain in the knee at the time of injury. The knee is swollen, varus deformity is seen in an internal condyle fracture, and a valgus deformity is seen in an external condyle fracture. Support is severely limited, active movements are not possible and passive movements are severely limited due to pain. It is not possible to raise the upright limb independently. Abnormal mobility is observed in the lateral movements of the joint.

The examination shows an increase in the cross-sectional area of the tibia at the level of the condyles compared to the healthy side. By applying gentle pressure to the condyles with a finger, the area of maximum pain can usually be clearly identified. There is pronounced hemarthrosis, which sometimes leads to local circulatory disorders. The joint volume is increased, and the anterolateral areas above and below the kneecap are swollen due to fluid accumulation.

complications

Sometimes condylar fractures are accompanied by compression of nerves and vessels. A fracture of the external condyle can be associated with a tear of the fibular neck and head, which can damage the oculomotor nerve, resulting in motor and sensory deficits in the area of innervation. After treatment, contractures of varying severity are often observed, which are due to prolonged immobilization, inaccurate positioning of the fragments, and scarring of soft tissues.

Osteoarthritis of the knee is considered one of the most important long-term complications. With complex fractures, inadequate treatment and inaccurate fracture fusion of the tibia, there is a tendency to rapid progression of degenerative changes and early disability, requiring the insertion of an endoprosthesis. Even with appropriate treatment and good functional results, osteoarthritis can develop 20-30 years after the injury.

How can chondromalacia of the kneecap be treated?

Once the diagnosis of chondromalacia of the kneecap is made, the doctor prescribes comprehensive treatment. This includes conservative pharmacotherapy (anti-inflammatory drugs and chondroprotectors), physiotherapy and surgery. The choice of therapeutic measures depends on the severity and location of the pathological process.

The surgery is performed to replace the cartilage surface of the kneecap or to implant artificial materials that act as cartilage. It can be performed through an open approach (a more traumatic procedure) or through arthroscopy.

Patient feedback after arthroscopic treatment of patellar chondromalacia is positive because the recovery time is shorter.

Your orthopedist will answer your questions about the treatment of chondromalacia of the kneecap and the duration of rehabilitation after an objective diagnosis.

Treatment of aseptic necrosis of the knee 2.jpg

Treatment of aseptic necrosis of the knee 2.jpg

Aseptic necrosis of the thigh tissue in the knee joint must be treated surgically in the following cases

• There is a tear in the meniscus;
• in the advanced stage of the disease, when more than 40 % of the width of the condyle have died;
• Conservative therapy fails and the pathology progresses contrary to treatment.

Most operations in Dr. Glazkova are performed using the arthroscopic method. These are minimally invasive procedures that are carried out through punctures in the knee area, without large incisions and without opening the joint cavity. After such procedures, the patient recovers faster, the likelihood of complications is lower, and the hospital stay is shortened.

Surgery for aseptic necrosis of the femoral condyle:

Microsurgical debridement. The doctor breaks up the damaged tissue and creates small lesions around the bone. These stimulate the regeneration processes, stop the tissue from dying and stimulate the healing process.

Decompression. A surgery to create one or more channels in the bone to relieve internal pressure. After this procedure, new blood vessels are formed, which improve the blood supply to the bone tissue.

Osteochondroplasty. Used to replace defects in bone and cartilage tissue. They are taken from other parts of the body. Artificial materials are also used less frequently.

Osteotomy. Removal of a dead piece of bone.

Single condylar endoprosthesis. It is used in the most severe cases. Doctors replace part of the knee joint with an artificial prosthesis.

If you have osteonecrosis of the knee, contact our medical center. We use innovative cell therapies, carry out minimally invasive procedures and, in most cases, can cure the disease without endoprostheses.

Diagnosis of fractures of the condyles of the femur and tibia

During the examination, the varus or valgus misalignment of the knee joint can be seen. It is enlarged and its contours are smoothed. Palpation reveals pain at the site of injury, sometimes crepitus, and effusion (hemarthrosis) in the knee joint, characterized by oscillation and ballooning of the kneecap. Positive sign of axial loading. Passive movements in the knee joint are painful and may be accompanied by a grinding sensation.

Laboratory and instrumental investigations

X-ray images in two projections clarify the diagnosis.

[4], [5], [6]

Treatment of femoral and tibial condylar fractures

Conservative treatment of fractures of the femur and tibial condyles

For fractures without dislocation, the knee joint is punctured, the hematoma is removed and 20 ml of a 2%igen procaine solution is injected. A circular plaster cast is applied to the limb stretched in the knee joint at an angle of 5° from the upper third of the thigh to the fingertips. In the event of a fracture of a single femoral or tibial condyle, the fixation of the limb is carried out with the addition of hypercorrection - tilting of the tibia on the fractured inner condyle outwards and vice versa, that is, to the healthy side.

Fractures of a single femoral condyle or fractures of the tibia with displacement are treated conservatively. Hemarthroses are treated. A 2%ige procaine solution (20 ml) is injected into the joint cavity and the tibia is tilted as far as possible to the side opposite the fractured condyle. The fingers are used to try to press the fracture against the material bed. The manipulation is carried out with the limb extended. The position achieved is secured in a functionally favorable position with a circular plaster cast from the groin fold to the fingertips.

The duration of immobilization for fractures of a femoral condyle is 4-6 weeks. The splint is then replaced with a movable splint and rehabilitation treatment is initiated, whereby the leg must not be put under any strain. After 8-10 weeks, the immobilization is removed and, after radiological control, the patient is allowed to carefully walk on crutches and gradually increase the load. Walking freely is only possible after 4-5 months at the earliest. The ability to work is restored after 18-20 weeks.

The treatment tactics for fractures of the tibial condyle are the same. Fixed immobilization 4-6 weeks, movable immobilization 8 weeks. Work is allowed after 14-20 weeks.

In case of fractures of both condyles with displacement, the fractures are fixed by pulling on the axis of the limb and compressing the condyles laterally with the hands or special devices (vise). The limb is immobilized with a circular bandage. If repositioning is ineffective, skeletal traction on the heel bone is performed with a load of 7-9 kg. After 1-2 days, a radiological examination is carried out. During this time, the fractures fuse in length, but sometimes there is a shift in width. This is eliminated by lateral compression of the fractures and a plaster splint is applied from the upper third of the thigh to the foot without interrupting the traction. The limb is supported on the splint and skeletal traction continues. It should be noted that traction, repositioning and cast immobilization is carried out with extension of the limbs up to an angle of 175°. Body weight is gradually reduced to 4-5 kg. Traction and permanent immobilization are removed after 8 weeks, then rehabilitation treatment begins. A mobile splint is indicated after 8-10 weeks for femoral condyle fractures and after 6 weeks for tibial condyle fractures. Return to work occurs in patients with fractures of both femoral or tibial condyles after 18-20 weeks.

• Fracture of the lateral condyle.
• tibia and fibula.
• fibula.
• Injury of the tibial condyle.
• The lateral dislocation is.
• Axis of rotation of the knee joint.
• Cracked metatarsal.
• External tibial condyle.