femoral condyle fracture
Introduction
Introduction to femoral condyle fracture Femoral condyle fractures accounted for 0.4% of systemic fractures, but their efficacy was not satisfactory. There are joint capsules, ligaments, muscles and tendons attached around the femoral condyle. The fracture block is pulled by these tissues, it is difficult to reset and it is difficult to maintain the reduction. The femoral condyle fracture can be complicated by extensive damage of the radial artery, nerve and surrounding soft tissue. In the case of adjacent support structures such as the collateral ligament and the cruciate ligament injury, the knee joint may be unstable, and the knee joint device may be adhered due to damage of the quadriceps and the supracondylar sac, which may impair the function of the knee joint. The fracture can cause the femoral condyle and the tibial plateau, the destruction of the corresponding joint between the tibia and the femoral articular surface, changing the normal anatomical axis and mechanical axis of the normal knee, destroying the normal load and conduction of the knee joint. Femoral condyle fractures are prone to bone separation without collapse, and are prone to "T" or "Y" fractures. Femoral condyle fractures include: intercondylar fractures of the femur, internal or external malleolus fractures, internal and external ankle fractures and comminuted Fractures, etc., in dealing with the location and type of upper fractures are difficult and different, and the prognosis is also quite different. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: edema
Cause
Causes of femoral condyle fracture
Femoral condyle fracture is prone to bone separation without collapse. This is because the triangular humerus is like a wedge pointing to the anatomical weak intercondylar fossa of the femoral condyle. It is easy to open the two, and the femoral shaft has a forward curved curvature, the front bone. The cortex is firm, and the posterior cortical bone is enhanced by the thick femur. Therefore, the fracture is likely to occur near the femoral condyle, and the cortical bone migrates into the weak part of the cancellous bone.
When the muscles around the patellofemoral joint contract, the femoral condyles are subjected to stress from both sides of the femoral condyle and the tibia. When the knee joint is extended to flexion, the stress between the patellofemoral joint and the patellofemoral joint surface increases to varying degrees. The combined force of the stresses is directed to the posterior superior tibia and femur of the femoral condyle. Whether it is the extension or flexion, there is always a part of the articular surface in contact. When the knee is flexed, the tibia is accompanied by anterior-posterior motion, and the injury. The knee joint is often in the same state of flexion, so that under the action of external force, it is beneficial to the wedge shape of the humerus. Therefore, the femoral condyle is prone to produce a "T" or "Y" type fracture.
Damage mechanism and type:
(1) Direct external force is more common in high-speed impact. The external force passes through the humerus to change the stress into a wedge force that causes a single or double ankle fracture. When the external force acts on the supraorbital area, it often causes an supracondylar fracture.
(2) The indirect external force falls from a height, and the knee joint is stretched or flexed. The stress in different directions may cause fractures at different parts of the lower part of the femoral condyle.
The knee joint often has physiological valgus, the stress of the lateral malleolus is more concentrated than the medial side, and the structure of the lateral malleolus is weaker than the medial side. Therefore, the injury is often in the lateral malleolus, and the valgus stress can cause the femoral external malleolus oblique fracture, sometimes producing an internal iliac crest. Avulsion fracture, medial collateral ligament tear or lateral tibial plateau fracture, varus stress can cause fracture of the femoral condyle. If the tibial plateau fracture occurs, the fracture line appears first in the humerus due to the strong resistance of the tibial plateau. On the lateral side of the spine, through the weak area of the diaphysis and metaphysis, and then to the inside, according to the fracture site and fracture type, there are the following:
1 single sacral fracture <external iliac crest, epiphysis> anterior, posterior, oblique, intermediate type. 2 intercondylar fracture "V" type, "T" type, "Y" type. 3 The upper fracture has a spiral shape, a diagonal shape, and a horizontal shape. 4 osteophyte separation. 5 cartilage and soft fractures of the bone.
Prevention
Femoral condyle fracture prevention
The disease is a traumatic disease, there is no effective preventive measures, usually pay attention to production and life safety, to avoid accidents is the key.
Complication
Femoral condyle fracture complications Complications edema
This disease often involves meniscus or ligament injury, but also should pay attention to vascular nerve injury, etc., some patients may also have osteofascial compartment syndrome:
Osteofascial compartment syndrome is a serious post-fracture complication. There are few reports of osteofascial compartment syndrome after supracondylar fracture of the femur. The supracondylar fracture of the femur is mostly caused by high-speed injury and high-altitude fall injury. For flexion and extension, the distal end of the flexion fracture is displaced to the posterior side by the quadriceps, the gastrocnemius and the contraction of the joint capsule. The strong contraction of the thigh muscle can cause the fracture to shrink, which is easy to oppress. Or damage to the brachial artery, veins and nerves, compression of the brachial artery and vein, blood flow reduction, aggravation of calf tissue ischemia, edema, increase the tissue pressure of the periosteal compartment, when the greater than arterial pressure, muscles produce heptamine due to ischemia Such substances increase capillary permeability, a large amount of plasma and liquid infiltrate into the interstitial space to aggravate edema, and the intraosseous tissue pressure is further increased, forming a vicious cycle of ischemia-edema, which eventually leads to muscle necrosis and nerve paralysis.
Symptom
Femoral condyle fracture symptoms Common symptoms Osteopathic pain Hip dislocation
Clinical manifestation and typing
Femoral condyle fractures are more common in emergency patients; the lower end of the femur is enlarged, with internal hemorrhoids and external hemorrhoids. There are joint capsules around the femoral condyle, ligaments, muscles and tendons attached. There is a groove-shaped intercondylar fossa between the two tendons, which is weak and easy to be used here. Fractures, femoral condyle fractures, can be complicated by the radial artery, extensive damage to the nerves and surrounding soft tissues, can be caused by adjacent support structures such as collateral ligaments, cruciate ligament injury, can cause instability of the knee joint, but also due to four heads Muscle, supracondylar sac injury causes knee extension adhesion, impairing knee function, fracture can cause destruction of the corresponding joint between the femoral condyle and tibial plateau, patella and femoral articular surface, changing the anatomical axis and mechanical axis of normal knee, destroying The normal load and conduction of the knee joint.
1. Local symptoms of fracture: mainly swelling of the knee, tenderness of the femoral condyle or internal and external iliac crest; conduction pain is also more obvious.
2. Knee joint dysfunction: due to intra-articular fractures, a little activity can cause severe pain, so the degree of joint function is more obvious.
3. Special examination: The blood (liquid) sign and the floating raft test in the knee joint are mostly positive and should be checked routinely.
4. Classification: According to the location and shape of the fracture, it is generally divided into the following four types:
(1) Single ankle fracture: refers to the internal or external iliac fracture only one side, which can be divided into the following two types:
1 non-displacement type: refers to fractures without displacement, or the longitudinal displacement of the fracture does not exceed 3mm, and the rotation does not exceed 5°.
2 Shift type: refers to the shift exceeding the above standard.
(2) Bractonia fracture type: refers to the internal and external iliac fractures, the shape of which is similar to V-shaped or Y-shaped, can also be called V-shaped fracture or Y-shaped fracture, generally accompanied by varying degrees of displacement.
(3) comminuted fracture type: generally except for the intercondylar fracture of the femur, more often with fractures on the sacral or adjacent sites, which are like T-shaped, called T-shaped fractures, the displacement of the fracture end is more obvious.
(4) Complex fracture type: refers to the ankle fracture with vascular nerve injury, and all types of displaced fractures may occur.
Examine
Examination of femoral condyle fractures
For patients suspected of having the disease, the following checks should be performed:
(1) The foot, toe activity, back and foot sensation, pulsation of the dorsal artery, and the possibility of nerve and vascular injury should be examined.
(b) If the patient's condition permits, the knee collateral ligament and the cruciate ligament should be examined at the same time.
(3) X-ray examination, taking the positive side of the knee.
(D) blood routine, blood type and clotting time check, elderly patients to check ECG and urine sugar.
Diagnosis
Diagnosis and diagnosis of femoral condyle fracture
For the diagnosis of this disease, combined with medical history and auxiliary examination can confirm the diagnosis, generally no need to identify, but clinically reported cases of misdiagnosis of tibia longitudinal fracture as the disease, suggesting that there is a certain similarity or confusing place. Should be identified.
When X-ray examination is performed on the patient, the tibia of the knee joint overlaps with the femoral condyle. The longitudinal fracture of the humerus is easily misdiagnosed as intercondylar fracture of the femur. The lateral and lateral humerus overlaps. If the fracture has no obvious dislocation, or X-ray The quality of the film is not high, and it is easy to cause misdiagnosis and missed diagnosis. For example, knee joint injury, especially in the case of knee injury, the possibility of longitudinal fracture of the humerus must be considered. It is necessary to perform the fracture test and lateral separation test. The axial slice of the humerus is diagnosed. An important basis for the longitudinal fracture of the humerus. If there is no fracture on the lateral side and there is blood in the knee joint, you must take the axial slice of the humerus. If the anterior segment has a longitudinal fracture, adding the axial fixation piece will help The understanding of the whole fracture, the axial slice is not obstructed by any bone tissue, so the display is clear, easy to find the longitudinal fracture of the humerus, if necessary, CT examination.
