Compression fracture of the tibia of the knee joint. Recovery after a fracture of the condyle of the tibia. The structure of the bones of the condyles of the tibia

Article content: classList.toggle()">expand

The knee and foot are connected to each other by the tibia and fibula of the lower leg. In appearance, this is a long tubular bone, which consists of 3 parts: the proximal, distal epiphysis (pineal body) and the body of the bone. Fracture of the lower leg in the tibia is a common injury that patients of all ages face.

The tibia fractures under traumatic force. The degree of fracture depends on the number of fragments, their placement, and the severity of damage to the soft tissues around the bone. The consequences of an injury can be the most dangerous. That is why it is important to provide first aid to the victim in time, and transport him to a medical facility.

Classification of fractures of the tibia

Depending on the mechanism of injury, fractures are:

• Inertial - the bone broke due to inertia due to impact;
• Compression - the injury occurred due to prolonged compression of the bone body;
• Impression - a crack as a result of indentation.

By type, fractures are divided into the following:

• Comminuted - a fracture with the formation of 2 or more fragments;
• Stable - there is a slight displacement of bone fragments;
• Helical - the line of pereshib covers the bone in a spiral;
• Transverse - the line of injury is perpendicular to the axis of the bone;
• Oblique - the line of injury is beveled;
• Displaced - bone fragments are displaced relative to each other.

A tibial fracture can be closed - the skin is not damaged, and open - the integrity of the muscles and skin is violated.

Depending on the structure of the tibia, fractures are divided into medial (middle), intra-articular (trauma to the bone inside the joint) and compression.

Depending on the location of the fracture line, the following types of tibial injuries are distinguished:

Fissures of the upper and lower parts of the bone are divided into intraarticular and periarticular.

Fracture of the intercondylar eminence

This is a rare injury that is preceded by overstretching of the ligaments. Even after a successful comparison of fragments, the ligamentous apparatus of the knee cannot function as before.

A fracture of the intercondylar eminence of the tibia is referred to as an avulsion fracture, that is, a fragment of the bone is torn off at the site of attachment of the tendon of the muscle. The line of injury passes through the upper end, and most of the articular surface is torn off the bone (in whole or in part), and sometimes chafed. Often, the injury affects the epiphyseal plate (cartilaginous growth plate).

Causes of injury

Due to the immaturity of the musculoskeletal system in children, a fracture of the intercondylar eminence is more common than in adults.

According to statistics, more than 65% of injuries of the intercondylar eminence of the tibia are provoked by non-contact sports.

Typically, a fracture occurs when the lower limb abruptly changes direction, stops, or lands from a height with a nearly extended knee.

During contact sports, there is an increased likelihood of injury at the time of forcible bending or turning inward. Most often, football players, basketball players, volleyball players, and skiers get injured.

Symptoms

It is possible to identify a fracture of the intercondylar eminence by the following symptoms:

• Strong pain;
• The victim cannot lean on the injured leg;
• Hemorrhage into the joint due to rupture of intra-articular vessels;
• Excessive looseness of the joint;
• Inflammation of the synovial (inner) membrane of the joint.

Similar articles

With a fracture of the tibia without displacement, passive movements are possible, but they are accompanied by pain.

Treatment

After reposition, a plaster bandage is applied to the injured leg, which fixes it from the ankle to the buttock in the overextension position. If the bone fragments are in the correct position, then the bandage is left for a period of 6 to 8 weeks.

Severe fractures require surgery. In this case, an arthroscopic operation is performed to compare the fragments, but this is not so easy to do because of the strong hemorrhage into the joint.

Non-crushed fragments are fixed with metal or absorbable screws. With a comminuted fracture, the fragments are fixed with thick suture material or wire.

Regardless of the method of therapy, the leg should be rested for 6 weeks. The cast is then removed and the joint is protected with a long articulated bandage that is placed over the knee.

Fracture of the condyle of the tibia

This is an intra-articular injury, during which the lateral sections of the superior pineal body of the tibia are damaged. Such a fracture is not uncommon, but not all injuries in this area can be attributed specifically to fractures. When damaged, the condyles are displaced by more than 4 mm.

Hidden fractures are more often diagnosed in older patients, which can be identified using x-rays. If a person complains of pain in the region of the condyles, then a diagnosis should be made.

Fracture of the condyles is complete and incomplete. In the first case, the condyle is completely or partially separated, and in the second, the cartilage is crushed, impressions or cracks appear.

During a condyle fracture, there is a risk of damage to the ligaments of the knee, the cartilage lining. In addition, this injury is combined with a fracture of the fibula and intercondylar eminence.

Causes of damage

Fracture of the condyles occurs under the influence of force with compression, which occurs along the axis with a turn. When the traumatic force exceeds the bone strength, a fracture occurs. In most cases, the injury occurs under the influence of a direct mechanism.

A condylar fracture is the result of a fall from a height. Often, an injury occurs as a result of a traffic accident, after hitting the middle (median) part of the bone with a car bumper.

Other fractures are caused by a combination of rotational stress and axial compression. The structure of the condyles is spongy, and therefore they are crushed during pressure. As a result, depressed fractures occur.

With a violent fracture of the leg, the lateral (middle) condyle of the tibia suffers. If the knee is extended at the time of injury, an anterior fracture occurs. Late condylar injuries form when the knee is bent.

Symptoms of injury

A fracture of the condyles of the tibia is determined by the following signs:

• Pain in the damaged area;
• Deformity of the leg in the region of the condyles;
• Hemorrhage in the joint;
• The functionality of the knee joint is impaired;
• Pathological lateral movements in the knee.

Pain depends on the severity of the injury. During palpation, the patient feels pain in the region of the condyles. Bleeding into the joint can be large, often because of it, the knee joint expands and blood flow is disturbed. In this case, it is important to pierce the articular bag and remove the contents. In order for the blood to resolve faster, you can perform early active movements in the joint (after the permission of the doctor).

A specific sign of injury is a deformity in the area of ​​the knee joint, which occurs due to the displacement of fragments.

The patient can only perform passive movements that are accompanied by painful sensations. In addition, there is lateral mobility in the knee area.

Diagnostic Measures

To determine the nature of the injury and the severity of the damage, x-rays are prescribed. This is the main method of instrumental diagnostics in this case. X-ray of the lower limb is performed in two projections. So the doctor will be able not only to clarify the presence of injury, but also to determine the nature of the displacement of the fragments.

If the results of the x-ray are ambiguous, then the victim is sent for a computed tomography of the knee. If the doctor suspects that soft tissues (ligaments, cartilage pads of the knee) are damaged, then there is a need for magnetic resonance imaging.

Sometimes nerves and blood vessels are pinched during injury. If the doctor suspects that the neurovascular bundle is damaged, then it is necessary to consult with a vascular surgeon and a neurosurgeon.

Methods of treatment

With a fracture of the condyle of the tibia, the treatment is divided into several stages:

• Early reposition of bone fragments to restore the congruence of joint surfaces;
• Fixation of the lower limb in the damaged area until the fragments grow together;
• Late active exercise of the injured lower limb.

The terms of treatment for a fracture of the condyle of the tibia, depending on the damage, can reach several weeks or even months. In case of a marginal fracture without displacement, an incomplete fracture or a crack, the injured leg is immobilized and a plaster splint is applied to it for 3-4 weeks. For 3-5 days after the injury, it is important to ensure the rest of the injured limb. The patient can then move around with crutches. During the day, the splint can be removed and active movements in the area of ​​the knee joint can be performed. You need to start with a minimum load, which is increased over time.

In case of a fracture of the condyle with a displacement, the method of adhesive traction for the lower leg is used when the leg is extended. In addition, side adjusting loops are used.

With a fracture of the lateral condyle of the tibia, the lateral loop is applied so that it is directed outward. The loop, which is placed above the ankles, is directed inwards. This method allows you to get rid of the deformation, set the bones and fix them in the desired position.

If both condyles are damaged, skeletal traction with lateral loops is used.. In some cases, manual reduction of fragments is carried out. During the procedure, general or local anesthesia is used.

After skeletal traction, exercises are performed after a few days if the patient does not have acute pain. Traction is eliminated after a month, after which the patient can move on crutches, but in such a way as not to burden the injured leg.

Surgical intervention is necessary if fragments in the joint cavity are infringed and movement is impaired, as well as when damaged by bone fragments of vessels and nerves. In addition, surgery is needed if conservative methods are ineffective and with strong compression of the condyles.

Complications

After a condyle fracture, there is a possibility of the following complications:

To avoid the above complications, treatment should be carried out on time, and the recommendations of the doctor should be followed. This is the only way to accelerate the restoration of motor activity of the knee joint.

Tibia body injury

The tibia is a long tubular bone that is often injured. The body of the tibia captures the area between the knee and ankle.

A fracture of a long bone provokes a large traumatic force, and therefore it is often combined with other injuries.

The lower leg consists of the tibia and fibula. The dimensions of the tibia exceed the dimensions of the small bone. It is a support for the body during the load, in addition. Between the upper and lower parts of the tibia is its body.

The severity of the injury depends on the traumatic impact on the bone. Often the tibia and fibula are fractured at the same time. A fracture of the body of the bone can be stable, displaced, transverse, oblique. Often diagnosed with a spiral, comminuted, open and closed type of damage.

Causes of the fracture

A fracture of the body of the tibia occurs as a result of a strong blow to the front of the lower leg. In most cases, this happens as a result of traffic accidents when a person collides with a car.

Often, after an accident, multi-comminuted fractures are diagnosed when the body of the bone splits into 2 or more fragments.

Injury to the lower leg is possible when practicing low-energy contact sports, such as football. That is, a fracture can occur even as a result of a collision between players. Also, such injuries occur under the action of a twisting force and are usually oblique or spiral.

Damage symptoms

To identify a fracture of the body of the tibia is quite simple, for this you should pay attention to the characteristic signs:

• Pain in the anterior part of the leg;
• The victim cannot lean on the injured limb and actively move it;
• Deformation appears on the middle part of the lower leg;
• The injured leg becomes unstable;
• A fragment of bone bulges under the skin or breaks it and comes out;
• In some cases, sensitivity in the foot area is disturbed.

After the onset of such symptoms, first aid should be given to the victim and transported to a medical facility.

Diagnostics

Upon arrival at the hospital, the patient should tell the doctor about how the injury occurred. If he fell from a height, then the approximate distance should be called. If the victim was previously injured, then this is also worth mentioning. This applies to serious diseases, such as diabetes. In addition, the patient should tell about what medications he is taking.

After collecting an anamnesis, the doctor conducts a visual examination of the injured limb in the shin area. If the victim is conscious, then his sensitivity and muscle strength are checked, for this he is offered to move his toes.

To clarify the diagnosis, the patient is sent for x-rays. This diagnostic method confirms or refutes a fracture of the bone body, allows you to see a displaced fracture and the number of bone fragments.

If the doctor suspects that the fracture has spread to the knee or ankle joint, then the patient is prescribed a CT scan.

Treatment Methods

During the preparation of treatment tactics, the orthopedist takes into account the cause of the injury, the general condition of the victim, the severity of the injury and the amount of damage to the soft tissue structures. The terms of treatment of a fracture of the tibia directly depend on these factors.

Conservative therapy is indicated in the following cases:

Bone fragments are fixed with a splint or plaster splint. Only in the first case, the bandage can be tightened or loosened, which guarantees the safe disappearance of puffiness. The plaster is removed after a few weeks, and then it is replaced with a functional plastic splint with a fastening mechanism. It supports the bones until they are completely fused. During washing or physical education, the tire is allowed to be removed

Surgery for a fracture of the body of the tibia is prescribed in the following cases:

• open fractures;
• Unstable injuries with the presence of highly displaced bone fragments;
• If conservative treatment was ineffective and the bones do not grow together.

In such cases, intraosseous osteosynthesis is often prescribed. During this operation, bone fragments are fixed with a metal rod (pin). Also for this purpose, special screws, screws and metal plates are used.

To speed up recovery, doctors advise to do physical exercises.

Complications

A fracture of the body of the tibia is a dangerous injury that provokes the following complications:

In the latter case, antibiotics are needed.

The operation can also provoke complications:

• It is impossible to combine bone fragments and restore its integrity;
• Penetration of infection into the damaged area;
• Damage to nerves, blood vessels;
• thrombus formation;
• Slow fusion of bones;
• Curvature of the injured leg.

The likelihood of leg curvature is possible when using an external fixation device.

First aid for a fracture of the tibia

With a fracture of the tibia, it is very important to provide competent first aid to the patient in time.

Instructions for first aid for a fracture of the tibia:

After providing prehospital care, the victim is transported to the hospital or an ambulance is called.

Injury diagnosis

Differential diagnosis will help the doctor determine the type of damage and prescribe competent treatment.

With a fracture of the condyles of the tibia, the doctor first of all conducts a thorough visual examination.

To determine the type of injury and severity, x-rays are prescribed. In addition, a diagnostic puncture of the joint is performed.

To confirm a tuberosity fracture, an x-ray of the tibia in lateral protection is taken. If soft tissue damage is suspected, magnetic resonance or computed tomography is prescribed.

Thus, a fracture of the tibia is a serious injury that requires timely detection and competent treatment.

Causes. Isolated fractures of the condyles occur when the lower leg is forcibly deflected outward, while the integrity of the tibial collateral ligament can be preserved, and the articular end of the tibia breaks off the lateral condyle of the femur. On the contrary, with forcible adduction of the lower leg, the medial condyle may suffer. Fractures of both condyles most often occur in a fall from a height on an outstretched leg or in a direct blow to the knee joint during car or motorcycle accidents. In such cases, apparently, a supracondylar fracture of the femur occurs first, and with continued violence, the end of the proximal fragment splits the condyles of the femur into separate fragments.

Signs.

In fractures without displacement of fragments, the axis of the limb is not broken and the predominant symptoms are severe pain in the knee joint and hemarthrosis. The contours of the joint are smoothed, its circumference is increased in comparison with the healthy one. Accumulated blood in the joint raises the patella. If you press on the patella, and then release it, then it will return to its previous position. This symptom is called patella ballot. The presence of a fracture of the condyles without displacement of fragments is established by radiography of the joint in two projections.

For isolated condylar fractures deviation of the lower leg outward (with a fracture of the lateral) or inward (with a fracture of the medial condyle) is characteristic. Movement in the knee joint is sharply limited, but there is a distinct lateral mobility. With fractures of both condyles, the lower leg deviates towards the most displaced condyle. Pronounced hemarthrosis and lateral pathological mobility. Movement in the knee joint is not possible. A characteristic difference between fractures of both condyles with displacement of fragments from isolated fractures is the shortening of the limb. The nature of the fracture and the degree of displacement of the fragments are determined by radiography.

Treatment.

Patients with fractures of the femoral condyles must be treated in a hospital.

Fractures without displacement of fragments. First of all, it is necessary to remove blood from the joint by puncturing it, followed by the introduction of 30-40 ml of 1% novocaine solution into its cavity for anesthesia. The limb is immobilized with a deep plaster splint. In the following days, punctures sometimes have to be repeated. From the first days, UHF therapy is prescribed through a plaster cast. After the disappearance of the effusion from the joint, the splint bandage can be replaced with a circular type splint up to the ankle joint, so that the patient can use shoes when walking. Further treatment is carried out in the clinic.

After 4-6 weeks, the splint is made removable and exercise therapy, massage and thermal procedures are prescribed. The patient at this time continues to use crutches while walking. Full load on the leg is allowed after 2-3 months.

Rehabilitation - 6-10 weeks.

With isolated fractures of the femoral condyles, an attempt at manual reduction can be made initially under local anesthesia. It is produced by deflecting the lower leg in the direction opposite to the damaged condyle. At the same time, the mixed condyle is pulled into place by the preserved lateral ligament. This technique is supplemented by compression of the condyles with hands or special devices (Novachenko, Kashkarova, etc.). Upon reaching a satisfactory position of the fragments, the limb must be immobilized with a circular plaster cast to the inguinal region; the bandage is immediately dissected along the anterior surface in order to avoid compression of the knee joint with an increase in hemarthrosis. The bandage is removed after 1 1 /g-2 months, and exercise therapy, massage and thermal procedures are prescribed. Full load on the limb is allowed after 3 months.

Ability to work is restored after 4-5 months.

Reposition is facilitated by skeletal traction behind the tibial tuberosity. After 1-2 months, skeletal traction is removed and exercise therapy is prescribed with physiotherapy. Skeletal traction is especially indicated for fractures of both femoral condyles with displacement of fragments (Fig. 107).

Complete restoration of the congruence of the articular surfaces of the condyles is achieved by open reposition and fixation of the condyles with metal structures. Operative treatment is especially indicated for fractures with wedging of the condyles. T-plate lag screws are used to secure the fracture. On the 2nd day after the operation, a partial load of 10-15 kg is allowed while walking with crutches. Further increase in load depends on the type of fracture and the reliability of osteosynthesis.

The duration of immobilization of the limb with a circular plaster cast is 6-8 weeks.

Rehabilitation - 14-16 weeks.

Ability to work is restored after 4-5 months. When using external fixation devices, the period of incapacity for work is halved.

Fractures of the condyles of the tibia

Arise most often when falling on straight legs or when the lower leg deviates outward or inward.

Clinical picture in fractures of the condyles of the tibia, it corresponds to intra-articular damage: the joint is enlarged in volume, the leg is slightly bent, hemarthrosis is detected by the symptom of balloting the patella. The tibia is deflected outwards in case of a fracture of the external condyle or inwardly in case of a fracture of the internal condyle. The transverse size of the tibia in the area of ​​the condyles is increased in comparison with the healthy leg, especially in T- and Y-shaped fractures.

On palpation, the area of ​​the fracture is sharply painful. Characterized by lateral mobility in the knee joint with unbent lower leg. There are no active movements in the joint, passive movements cause sharp pain. The patient cannot raise the straightened leg. Sometimes damage to the external condyle is accompanied by a fracture of the head or neck of the fibula. In this case, the peroneal nerve can be damaged, which is recognized by a violation of sensitivity, as well as motor disorders of the foot.

X-ray examination allows you to clarify the diagnosis and identify the features of the fracture.

Treatment.

With fractures of the condyles of the lower leg without displacement produce a puncture of the joint for aspiration of blood and the introduction of 20-40 ml of 1% solution of novocaine. The injured limb is fixed with a circular plaster cast (Fig. 83). From the 2nd day, exercises for the quadriceps femoris are recommended. Walking with crutches without weight on the affected leg is allowed after a week. The plaster bandage is removed after 6 weeks. Loading of the leg is allowed 4-4.5 months after the fracture. With early loading, impression of the damaged condyle may occur.

With a fracture of the condyle with displacement applied both conservative and surgical treatment.

Surgical treatment is indicated with unsuccessful conservative treatment. The operation is performed 4-5 days after the injury: open reposition of the fracture and osteosynthesis with metal structures. The sutures are removed on the 12-14th day, and further management of the patient, as in case of fractures of the condyles without displacement

radiographs usually occur with forcible abduction of the leg. Fractures of the medial platform are usually the result of strong adduction of the distal tibia. If the knee is extended at the time of injury, an anterior fracture is more likely to occur. Most late condylar fractures occur with trauma when the knee joint was bent at the time of impact.

​Hidden​ Based on anatomical features

Without timely reposition of fragments, the prognosis is poor in terms of knee function. Deforming arthrosis develops.

A fracture of the condyle without displacement is subject to conservative treatment. Apply a plaster cast with a pelvic girdle for 12-14 days, then prescribe a massage, active movements. Careful loading with crutches is allowed by the end of the month. For ordinary fresh injuries, an arthrotomy is performed. Fragments lying freely in the joint cavity are removed. Large fragments are set and fixed with a screw, nail, knitting needles or special L- and T-shaped support plates. With multi-comminuted injuries and open fractures, external osteosynthesis is performed using the Ilizarov apparatus. Fracture of the condyles of the tibia is an intra-articular injury to the lateral sections of the upper epiphysis of the tibia. It occurs in people of any age and gender. It occurs as a result of a direct blow to the area of ​​the knee joint, a fall on the knee or on straightened legs (in the latter case, as a rule, fractures are formed with the impression of fragments). Sometimes this type of tibial fracture is observed in a road traffic injury due to a knee hit on the front panel. Fractures of the lateral condyle are most often diagnosed, fractures of both condyles are the second most common and fractures of the internal condyle are the third.

Grade A: tibial condyle fractures

. These fractures usually involve the internal condyle and may be anterior or posterior. The recommended method of treatment is open reposition with internal fixation. An x-ray with the removal of the projection of the articular site and stress tests are required to determine the integrity of the ligaments of the knee joint. If the ligaments are damaged, prompt repair is indicated. Conservative treatment of a fracture without displacement and damage to the ligaments includes: 1) aspiration of blood in case of hemarthrosis; 2) the imposition of a pressure bandage or back splint for a period of several days to 3 weeks with complete unloading of the limb; 3) early consultation with an orthopedist. If sick

depends on the type of fracture, the experience and skill of the orthopedic surgeon, the age of the patient and his discipline. An urgent consultation with an orthopedic surgeon is strongly recommended. The knee joint should be carefully examined for avulsions of the fibular head, femoral condyles, and intercondylar eminence, indicating ligamentous injury. Joint space expansion combined with a fracture of the opposite condyle suggests ligament injury. To identify hidden compression fractures, tomograms may be needed. As a rule, the patient

fractures of the proximal tibia​Thank you for reading, get a gift!​

In case of a fracture of the condyles of the tibia with displacement, it is proposed to use traction: for fractures of one condyle - adhesive traction, for fractures of two - skeletal traction by the ankles. Two adjusting side loops are applied. One of them is located directly above the joint space in the knee area. The thrust from it is directed towards the broken condyle. The second lateral loop is located on the lower leg directly above the ankle joint. In case of fresh fractures with significant compression, uncorrected and chronic fractures, as well as secondary subsidence of the condyles due to premature load on the leg, osteoplastic surgery according to Sitenko is performed. The joint is opened, osteotomy is performed, the upper fragment of the condyle is raised so that its articular surface is at the same level and in the same plane with the surface of the second condyle, and then a wedge made of autogenous or heterogeneous bone is inserted into the resulting gap. Fragments are fastened with lag screws and a plate. Fractures can be complete or incomplete, with or without displacement. Incomplete injuries include cartilage crush, limited depressions and cracks. Complete damage is accompanied by separation of the entire condyle or part of it. Fractures of the condyles can be combined with damage to the ligaments of the knee joint, damage to the meniscus, fractures of the fibula and intercondylar eminence. Fractures of other limb bones, TBI, fractures of the pelvis and spine, blunt trauma to the abdomen and injury to the chest can also be detected in motor vehicle accidents and falls from a height.​

Class A: Type VI (comminuted) hospitalized​Class A: Type I (no offset)​

Projection of the articular area of ​​the tibia complains possible in the elderly. Primary radiographs appear normal; nevertheless patients continue to complain of pains, especially in the field of an internal condyle. These fractures are fatigue fractures and should be scanned if suspected.

​can be divided into five categories: Grade A: condylar fractures Grade B: tibial tuberosity fractures Grade D: subcondylar fractures Grade D: epiphysiolysis fractures, proximal fibula fractures ​(Visited 36 times, 1 visits today)​ In case of fracture of both condyles, it is recommended to use loops that penetrate one through the other in different directions.

After osteosynthesis, the wound is sutured in layers and drained. With stable fixation, immobilization in the postoperative period is not required. The drainage is removed for 3-4 days, then exercise therapy with passive movements is started to prevent the development of post-traumatic contracture of the joint. Assign thermal procedures. After reducing pain, they move on to active development of the joint. A light axial load on the limb with conventional osteosynthesis is allowed after 3-3.5 months, during bone grafting - after 3.5-4 months. Full support on the leg is possible after 4-4.5 months. At the time of the injury, a sharp pain appears in the knee. The knee is enlarged in volume, with a fracture of the internal condyle, varus deformity can be detected, with a fracture of the external - valgus. Movement and support are sharply limited. Pathological mobility is observed during lateral movements in the joint. Gently pressing on the condyles with one finger, you can usually clearly define the zone of maximum pain. There is a pronounced hemarthrosis, which sometimes causes a sharp expansion of the joint and disturbances in local blood circulation. Emergency care for these fractures includes ice, elevating the limb, immobilization with a posterior splint, aspiration of blood for hemarthrosis (with strict asepsis), and hospitalization for skeletal traction.​

, Buck skeletal traction with active movement exercises is recommended.

. In an adherent outpatient without associated ligament injuries, a non-displaced condyle fracture can be treated with aspiration of the hemarthrosis followed by the application of a pressure dressing. An ice pack is applied to the limb and an elevated position is given to it for at least 48 hours. If after 48 hours the radiographs remain unchanged, movements in the knee joint and exercises for the quadriceps femoris can begin. Until complete recovery, the leg should not be fully loaded. You can use partial load with walking on crutches or a plaster splint. Fractures of the condyles of the tibia

Treatment of fractures of the tibial condyles

for pain and swelling, with his knee slightly bent. On examination, there is often an abrasion indicating the site of impact, as well as effusion and decreased range of motion due to pain. Valgus or varus deformity usually indicates a broken condyle. After plain radiographs are taken, stress-bearing radiographs may be required to diagnose occult ligament or meniscus injuries.​ Forces normally acting on the articular Fractures of the condyles of the tibia

Fractures of the proximal tibia In case of insufficient effectiveness of the treatment, a special removable device is used, which consists of an arc and three pilots. Two pads put pressure on the condyles of the leg, the third is placed in the area of ​​the tuberosity of the tibia. By rotating the screws of this pilot, it is possible to achieve metered pressure on the condyles of the tibia.

The prognosis with an adequate comparison of fragments, compliance with the doctor's recommendations and the timing of treatment is usually satisfactory. The lack of complete anatomical reposition, as well as premature axial load on the joint, can provoke subsidence of the fragment, which causes the formation of valgus or varus deformity of the limb, followed by the development of progressive post-traumatic arthrosis. The main method of instrumental diagnostics is radiography of the knee joint. X-rays are performed in two projections. In the vast majority of cases, this will make it possible to reliably establish not only the fact of the presence of fractures, but also the nature of the displacement of fragments. With ambiguous results of radiography, the patient is referred for a CT scan of the joint. If concomitant damage to soft tissue structures (ligaments or meniscus) is suspected, an MRI of the knee joint is prescribed. Sometimes fractures of the condyles are accompanied by compression of the nerves and blood vessels, if damage to the neurovascular bundle is suspected (damage to the vessel and nerve damage), consultations of a vascular surgeon and a neurosurgeon are prescribed.

Fractures of the condyles of the tibia

​Class A: Type III (compression, with condylar detachment)​ Staying in a plaster cast for more than 4-8 weeks from the moment of injury to a disciplined patient is not recommended due to the high incidence of contractures of the knee joint. If the patient is an outpatient and does not have ligament injuries, but at the same time is undisciplined, immobilization with a plaster cast is recommended. Active isometric exercises for training the quadriceps femoris should be started early, and the cast should be left until complete healing. Hospitalized patients without ligament injuries are usually treated with skeletal traction combined with early movement exercises.​

often combined with a number of serious injuries of the knee joint. 1. These fractures are often accompanied by damage to the ligaments and menisci, both individually and in combination. A fracture of the lateral condyle should be suspected of injury to the collateral ligament, anterior cruciate ligament, and lateral meniscus. 2. After these fractures, either acute or later vascular damage can be observed. For site are often found. They have been classified by Hohl based on anatomical findings and treatment principles. Considering fractures of the condyles of the tibia, it should be noted that under the fracture of the condyle they mean a downward displacement of more than 4 mm. Serious deformity of the knee joint can occur after seemingly minor fractures of the proximal tibia in children. Its reason remains unclear. It appears in children under 4 years of age and manifests itself as a valgus deformity of the knee joint 6-15 months after the injury. Includes fractures located above the tibial tuberosity. They should be divided into extra-articular and intra-articular. Intra-articular fractures include damage to the condyles, while extra-articular fractures include fractures of the intercondylar eminence, tubercles, and subcondylar fractures. Epiphyseal fractures of the tibia are considered intra-articular. Fractures of the proximal fibula are not of particular importance, since the fibula does not carry a weight load.

However, with a displaced fracture of the tibia condyles, it is often not possible to accurately reposition the fragments. Surgical treatment is recommended. With a fracture of the tibial condyles, the mechanism of damage, some symptoms and the subsequent course are very similar to those for a fracture of the femoral condyles.

Treatment of this pathology is carried out in the conditions of the trauma department. Upon admission, the traumatologist performs a puncture of the knee joint and injects novocaine into the joint to anesthetize the fracture. Further tactics are determined taking into account the characteristics of the damage. In case of incomplete fractures, cracks and marginal fractures without displacement, plaster is applied for 6-8 weeks, walking on crutches is prescribed, the patient is sent to UHF and exercise therapy. After the termination of immobilization, it is recommended to continue to use crutches and not lean on the limb for 3 months from the moment of injury. May be accompanied by the development of several serious complications. 1. After prolonged immobilization, a complete loss of movement in the knee joint is possible. 2. Despite optimal treatment, degenerative arthrosis may develop. 3. Even with initially non-displaced fractures, angular deformity of the knee joint may develop in the first few weeks.​

. Emergency management of these fractures includes ice, posterior splint immobilization, and accurate x-ray diagnosis with prompt referral. Treatment ranges from cast immobilization with unloading of the limb to operative reposition or skeletal traction. Grade A: Type II (local compression)

The four most detection of these fractures

Complications of tibial condyle fractures

tibia, include compression along the axis with simultaneous rotation. Fractures occur when one of the forces exceeds the strength of the bone. Fractures resulting from a direct mechanism, such as falls from a height, account for about 20% of condylar fractures. Road traffic accidents, where the bumper of a car strikes the proximal tibia, are responsible for approximately 50% of these fractures. The remaining fractures are caused by a combination of axial compression and simultaneous rotational stress. ​It seems that the development of this​

Inner and outer condyles of the tibia

A condyle is a thickening at the end of a bone to which ligaments and muscles are attached.

It is more fragile, as it is covered with cartilage. The cause of injury is:

• strong blows when falling;
• car crashes;
• bad straightening of the leg.

Types and symptoms

According to the existing classification, medial and lateral, anterior and posterior, external and internal fractures of the tibial condyle are distinguished. The features of the affected anatomical region, the presence of bone fragments, as well as the presence / absence of damage to both condyles are taken into account.

The general symptomatology is reflected by pain, swelling. The injury site is tactilely warmer than the rest of the leg. A hallmark of fractures of one condyle is deformity of the knee. The intensity of the pain cannot be judged on the degree of damage. To clarify the nature of the fracture, X-rays are used, less often - computed tomography.

Compression fracture

Violation of the integrity of the bone tissue associated with compression. Such injuries are the result of prolonged exposure to a damaging agent. With an intra-articular fracture, the surface of the tibia and fibula is affected.

crushed fracture

Often occurs as a result of car accidents, accompanied by dissection of the bone into fragments that damage the surrounding soft tissues and blood vessels. The type of fracture is dangerous for internal bleeding and difficult to treat.

For fixation of bone fragments and the possibility of its restoration, the Ilizarov apparatus is used.

impression fracture

Otherwise called depressed. The blow falls in the region of the intercondylar eminence, which leads to injury. The reason may be a jump from a height.

Consolidated fracture

Damage to bone tissue at the stage of consolidation, that is, recovery. Splicing is not always smooth, especially if there are many fragments. The callus is easily exposed and damaged.

Fracture of the lateral condyle

It is most common after a car accident and among athletes. An x-ray will show how much the lateral tibial condyle has shifted. The fault line will be oblique or vertical. If exposure to the traumatic agent continues, the fragments will move. It is necessary to provide rest to the injured leg.

Fracture of the lateral condyle

This type of injury occurs if the knee is bent more than 45° at the time of the accident, as well as in sports and after an accident. Radiologically, damage can be considered in frontal or lateral projection. If the problem is not visible on standard images, and the pain syndrome remains, then a fracture of the lateral condyle of the tibia is detected using an oblique projection.

Diagnostics

Symptoms are similar to hip fractures. An x-ray is needed to make a correct diagnosis. A consultation with an orthopedic surgeon is required. The clinical picture and the collection of anamnesis are important, but without an X-ray, it will be very difficult to assess the situation and think over the tactics of treatment.

You can visually diagnose a fracture using manipulations:

1. Carefully take the injured limb with your hands and try to bend at the knee. The patient will feel pain, but the leg will remain motionless.
2. On a previously immobilized leg, when you try to press your fingers on the patella, it will move unnaturally, causing discomfort.
3. Tapping on the heel and lower leg will increase the pain.

If the injured area is painful and visibly swollen, see a specialist as soon as possible.

Fracture treatment

It is based on two methods: conservative and surgical. The tactics of treatment is determined by the patient's condition. Self-repositioning is not allowed!

The tactics of recreational activities depend on the type of fracture:

1. No displacement: has the most easy flow. Use pressure bandages for a period of 4 to 8 weeks, monitor the dynamics and recommend not to load the leg.
2. Local compression: take into account the localization of damage, the presence of fragments and associated violations of the integrity of the ligaments. During hospitalization, plaster fixation is used.
3. Partial avulsion of the condyle: Accurate X-ray diagnosis is needed to identify the position of the bone parts. Plaster immobilization to skeletal traction is shown.
4. Avulsion of the condyle: implies a detachment of 8 mm or more. Treatment is operative.
5. Spall: the internal condyle is captured. Apply open reduction with internal fixation.
6. Comminuted: with such fractures, the presence of internal bleeding is implied. Strictly observing the rules of asepsis, the patient is hospitalized for skeletal traction. An x-ray will help to understand the location of the fragments.

conservative methods

Shown with a slight displacement of the condyle and the absence of fragments. They use cold to relieve swelling, pressure bandages and immobilization of the knee in an orthopedic apparatus. The displacement of fragments is prevented by a plaster bandage. Loads on the leg are contraindicated.

Surgical methods

In more severe cases, surgical methods of treatment are used to treat a fracture of the condyle of the knee joint.

• open and closed reduction;
• osteosynthesis;
• fixation of fragments using the Ilizarov apparatus.

Any method of treatment involves inpatient observation.

Rehabilitation

During the fusion period, the resulting callus is highly susceptible to external factors and can easily be damaged. The doctor makes sure that the medial and lateral edges of the articular surface are restored equally. To speed up the process use:

• inclusion in the diet of foods containing calcium;
• resumption of movements in the knee joint;
• limiting the load on the injured leg;
• physiotherapy procedures that prevent the development of dystrophy;
• rubbing and therapeutic massage.

In addition to well-known dairy products, a lot of calcium is found in cabbage, sorrel, fish and almonds.

Complications

After damage to the tibia, there is a high risk of facing the consequences:

• complete or partial loss of movement in the fracture area;
• development of degenerative arthrosis;
• deformity of the knee joint;
• damage to ligaments by bone fragments;
• surgical treatment complicated by infection.

Prevention of fractures

It is important to take care of nutrition, your own safety, and choose the right clothes.

In order for calcium to be absorbed by the body and not washed out of the bones, vitamin D must be supplied in sufficient quantities. The daily norm for an adult is 600 IU.

Choose clothes according to the season. Slippery autumn boots in winter ice are far from the best choice.

Moderate physical activity will strengthen the muscles and ligaments, creating a natural defense for the inert tissue. Walking on crutches (during the rehabilitation period) will help to properly distribute the load on the limb.

A fracture of the tibial condyle (with or without displacement) is an unpleasant phenomenon. However, correctly chosen treatment tactics and adequate rehabilitation will help to avoid possible complications.

The largest medical portal dedicated to damage to the human body

From the side of the anatomical structure, the tibia is a junction of two bones - small and large. Since the latter is one of the largest in the human body, rehabilitation after a fracture of the tibia takes a lot of time, effort and special efforts of the patient and the doctor to fully restore the damaged integrity and functionality.

Due to the fact that the tibia is responsible for the main load of the whole body, it is subjected to injuries very often. A characteristic feature of such injuries is the risk of various complications that can complicate the treatment process and prolong the patient's recovery.

More about trauma

In accordance with the classification of the above injury in modern medicine, a fracture can be:

An uncomplicated and easiest type of damage is considered stable, which is characterized by an insignificant displacement of the injured bone from its axis. At the same time, with a displaced form, the broken parts of the bone are completely separated from each other, requiring surgical restoration of their normal position.

With a transverse injury, a fracture of the bone is observed, which runs perpendicular to the axis. In most cases, fragments are located close to each other, provided that they are held by the fibula. If the blow leads to a combined fracture of the tibia and tibia, then the elements can move a considerable distance, so the treatment instruction recommends operative reposition.

It is possible to determine the presence of an oblique fracture using an x-ray. With untimely treatment, bone fragments can significantly shift to the side, so the injury requires the immediate provision of emergency medical care.

In most cases, a spiral or helical fracture of the lateral condyle of the tibia can occur in the event of an impact with the leg fixed in one position. The stability or instability of the damage is influenced by the breaking pressure.

Important! Depending on the number of bone fragments, a comminuted type of fracture can be stated. It is distinguished by the presence of fragmentation of the tibia into three or more elements, displaced in relation to each other.

As for the open injury, it is easily diagnosed due to soft tissue damage and the presence of a part of the damaged bone that can be seen from the wound. A characteristic sign of an open fracture is intense blood loss, damage to muscles, ligaments and tendons. In addition, an open wound is dangerous with an increased risk of infection in the body of the affected person.

When the injury is closed, the soft tissues remain intact. Due to the complexity of the damage, such a fracture can most often be treated during surgery. Hematomas of a significant size, impaired blood flow and edema can indicate a broken integrity of the bone structure. In some cases, the patient has to amputate the lower limb.

Mechanism of injury and symptomatic signs

Given the strong nature of the above bone in the human body, in the predominant number of clinical cases we are talking about a crack.

Despite this, in the video in this article it is possible to get acquainted with the common causes of a violation of the integrity of the human tibia:

• traffic accidents (so-called "bumper injury");
• falling from a considerable height;
• injuries of industrial or sports origin;
• exerting significant pressure or receiving a strong blow to the limb.

If such damage is suspected, the victim should immediately seek qualified medical attention.

It must be emphasized that the doctor confirms or refutes the suspected diagnosis after a thorough examination of the results of the X-ray image in two projections and diagnostic palpation of the area of ​​injury. In complicated forms, a computed tomography may be additionally prescribed, the price of which is relatively higher than conventional radiography.

From a visual point of view, the impaired integrity of the tibia is characterized by the following manifestations:

Features of treatment and recovery techniques for trauma

In order to determine what rehabilitation should be like for a fracture of the tibial condyle, it is necessary to pay special attention to the applied method of treating the above traumatological problem. When ascertaining minor fractures, it is sufficient to apply a plaster fixation bandage to completely cover the lower limb and securely immobilize the heel at a normal angle.

It is worth paying attention to the fact that in most cases, the rehabilitation period after a fracture of the tibial condyle is limited to a period of more than two months.

A significant recovery period is associated with a rather large size of the damaged bone. During treatment, the patient is allowed to use crutches for movement, but in no case step on the injured lower limb.

Therapy of the above diagnosis can be both conservative and radical. Rehabilitation after a fracture of the tibial condyle also depends on the type of treatment chosen, since it is associated with damage to adjacent soft tissues and complications.

For immobilization, a splint or a plaster splint can be used. It is worth wearing it for several weeks, which directly depends on the degree of restoration of the damaged bone.

After the plaster is removed, rehabilitation begins after a fracture of the condyles of the tibia. It consists in additional support with the help of special fastening mechanisms. Thus, the bone remains in one reliable position until the moment of complete fusion.

The patient is allowed to remove the fixing splint only if it is necessary to undergo physiotherapy exercises.

The most popular type of treatment in terms of its effectiveness is intramedullary osteosynthesis. It consists in inserting a fastening intra-articular pin, thanks to which it is possible to connect bone fragments until the integrity of the bone structure is fully restored. The pin must be fixed in such a way that the screw connections are located on opposite parts.

A very traditional method of treatment is the imposition of screws and plates. After the bone integrity is restored, the specialist proceeds to fasten all bone fragments, which is possible thanks to plates and screws. Thus, the reliability and normal position of the lower limb and the damaged bone are ensured for its proper fusion within a short time.

A not very common method of treatment is external fixation, which consists in attaching special screws to maintain the correct shape of the damaged bone during the application of medical techniques and various rehabilitation procedures of the recovery period.

It should be noted that rehabilitation after a fracture of the tibial condyle depends on procedures for the speedy restoration of the integrity and functionality of the injured area. Immediately after the removal of the plaster cast or splint, the patient will not be able to perform the functions that were possible before the injury.

The recovery period is characterized by the presence of:

• active movements without intense loads using crutches for support;
• massage procedures for warming up muscles, improving blood circulation and speedy strengthening and recovery;
• physiotherapy procedures effective for the fastest tissue regeneration and nutrition of injured tissues around the fracture site;
• physical therapy, which consists of special exercises carried out under the supervision of a qualified specialist;
• taking painkillers, since the above injury is often accompanied by severe pain;
• the use of anti-inflammatory drugs, since an inflammatory process may develop due to damage, which negatively affects the effective restoration of the integrity and functionality of the bone;
• the use of vitamins D and C, as well as calcium, which positively affect the functionality of bone tissue.

As for physiotherapy exercises, it should be based on the passive development of the lower leg (this can be flexion and extension of the injured lower limb in the area of ​​the knee and foot). Efficiency is distinguished by movements in the position of a person lying down with raising the injured leg up.

Two weeks after the start of rehabilitation, it is worth starting to do half squats and then full squats. Basically, treatment is limited to four months, and the rehabilitation period lasts for six months. If we are talking about open complicated injuries, then after them a little more time may be needed.

Average treatment time for tibial condyle fracture and factors affecting recovery

A fracture of the condyle of the tibia, the terms of treatment are prescribed by a specialist after a thorough examination of the patient. Much depends on the victim. It is important to follow all the recommendations of the doctor and not deviate from the treatment regimen. Damage of this nature affects the lateral sections of the upper part of the tibia. This is an intra-articular fracture that occurs as a result of receiving a direct blow. It is impossible to leave him unnoticed. The person immediately feels severe unbearable pain and limited mobility.

Fracture symptoms

After an injury in the area of ​​the knee joint, there is a pronounced swelling. Often it is accompanied by hemorrhage into the cavity of the affected area. If the fracture is serious with displacement, then valgus or varus deformity of the knee joint is fixed.

On palpation of the condyle of the tibia, a person feels acute pain. It is also observed during movement and the provision of axial load. must be differentiated from damage to the menisci, ligaments, joints and other parts. In this case, the treatment regimen is somewhat different, so it is important to correctly diagnose. X-rays play an important role in the diagnosis. It is she who allows you to get an accurate diagnosis and get acquainted with the nature of the damage.

At the time of injury, a person notices the following symptoms:

• sharp and severe pain in the affected area;
• instant swelling;
• hemorrhage;
• hematoma.

Often the clinical picture is complemented by a pronounced shift. The movements of the victim are limited, moreover, they deliver a lot of discomfort. In this case, pathological mobility of the joint can be observed. Gentle pressure on the fracture of the tibial condyle allows the specialist to feel the most painful area. During the examination, pronounced hemarthrosis is fixed, sometimes it contributes to disruption of local blood circulation.

When an injury occurs, it is important to immediately begin diagnostic measures. This will allow you to quickly diagnose and prescribe the optimal treatment regimen. The main research method is radiography. Thanks to her, it is possible to get the most complete picture of the damage. X-rays are taken in two projections, which allows you to fully explore the affected area. In many cases, radiography fixes the fracture.

If during the study the doctor received an ambiguous result, it is recommended to resort to additional diagnostic methods. It can be computed or magnetic resonance imaging. With complex damage to the condyle of the tibia, compression of the nerves and blood vessels is recorded. In this case, it is advisable to consult a neurosurgeon.

Methods and methods of therapy

If the lateral condyle is damaged, and the fracture is serious, then the treatment is carried out in a hospital. A person needs to tune in to a long recovery process. If the fracture is not aggravated by displacement or severe injury, it will take approximately 8 weeks.

Upon admission to the trauma department, the patient is given a puncture of the knee joint. Then novocaine is injected into the cavity, which allows you to relieve acute pain. With a simple fracture of the condyle of the tibia, a plaster is applied for a period of 2-3 months. The further course of treatment depends on the recovery of the person. This may be affected by some features of the damage and the condition of the victim himself. During recovery, it is necessary to move around on crutches, bed rest and complete lack of movement are not assigned. During the period of active fusion of the fracture, you should attend physiotherapy procedures and resort to the help of physiotherapy exercises. When a person's condition improves significantly, he will have to use crutches for some time. Tension of the tibial condyle can aggravate the situation, so leaning on the limb is not recommended for 3 months.

If the damage is accompanied by displacement, then one-stage manual reposition is applied. With a fracture of the tibial condyles, skeletal traction is used. During recovery, a person is actively engaged in physiotherapy exercises. A light load on the joint is allowed after 2 months, you can fully stand on your leg no earlier than a week.

In any case, the patient will have to tune in to a long recovery.

Often, to eliminate a fracture of the condyle of the tibia, they resort to surgical intervention. This is due to the lack of a therapeutic effect when using conservative methods of treatment. Surgical intervention is appropriate in cases of vascular compression, the presence of fragments and damage to fragments in the joint cavity.

Ordinary injuries are eliminated by the use of arthrotomy. So, if there are fragments in the joint cavity, they are removed. Large fragments are reduced and fixed by means of a screw, nail or special knitting needles. In the presence of a significant number of fragments, the Elizarov apparatus is installed.

Fresh fractures of the condyle of the tibia are eliminated with the help of osteoplastic surgery. After the intervention, a person goes through a recovery process for a long time. The operation is based on opening the joint cavity, removing fragments and tightening them with screws and plates. 4 days after surgery, a person resorts to the help of physiotherapy exercises. The patient will be able to fully lean on the leg after 5 months.

With timely and adequate treatment, the prognosis is positive. During this period, it is important to follow all the recommendations of the doctor. Do not rely on a sore leg and resort to serious physical exertion.

How long is a tibial condyle fracture treated?

Limb fractures are among the most common. Especially their number increases in winter, when icing of sidewalks appears, which are reluctant to clean in our country. One of the most severe injuries of the articular surfaces, they bring a lot of trouble, take a very long time to heal and heal rather poorly. When diagnosing problems of this kind, a limb can shackle a person in plaster for a long time.

One of the most common leg injuries is a tibial condyle fracture. It can be both impression (intra-articular) and compression. Problems of this kind are especially common in people who have fallen from a height (for example, from a ladder, from a tree, or even from a window), while the legs must be in an unbent position. Today we’ll talk about how troubles of this kind are treated, how long they heal, and how rehabilitation after an injury goes.

What is this injury?

The condyle is a thickening at the end of a bone to which muscles and ligaments attach. There are two of them on the tibia:

The condyles are a rather fragile part of the bone, because, unlike the bone itself, they are covered with cartilage. It is more elastic and much less resistant to all kinds of damage.

As we said above, the cause of injuries of this kind are falls from a height and landing on even legs. If something like this is noted, the condyles are strongly compressed and the dense section of the metaphysis is pressed into the spongy substance of the epiphysis. Ultimately, the epiphysis is divided into two parts, due to which the outer and inner condyles simply break. A fracture may appear as two of these parts of the joint, or one of them. You can tell them apart by one simple feature:

• if the lower leg moves to the outside - problems with the external condyle;
• if the lower leg moves inward, the internal condyle is broken.

The classification of injuries of this kind is quite extensive. First of all, complete and incomplete damage is distinguished. In the first case, a complete or partial separation of the condyle is noted. If the fracture is incomplete, then cracks, indentation may be noted, but separation is not observed. In general, injuries are divided into two large groups:

Condyle injuries are often diagnosed with a number of concomitant injuries. These include trauma to the fibula, ruptures or tears of the knee ligaments, menisci, fractures of the intercondylar eminence.

Characteristic manifestations and diagnosis

It is not difficult to identify fractures of this kind. First of all, the specialist will pay attention to the characteristic symptoms of an injury, which include:

• soreness;
• hemoarthritis;
• dysfunction of the joint;
• deformation characteristic of such injuries;
• lateral movements in the knee joint.

It should be noted that pain in condyle fractures may not correspond to the complexity of the injury. Therefore, when diagnosing a problem, palpation is performed - feeling the area of ​​\u200b\u200bdamage. Specialists do this in order to determine pain at specific points. Moreover, you can find out the nature of the injury yourself. It is enough just to slightly press on the area of ​​​​the knee joint. If you feel discomfort, then you need to urgently visit the nearest medical facility.

Another characteristic sign of injuries of this kind is hemoarthrosis, which can reach a fairly large size. The essence of this problem is an increase in the volume of the joint, which causes circulatory disorders. If something like this is noted, the specialist will have to urgently refer the patient to a puncture. This procedure will help remove the accumulated blood.

You can also determine the damage yourself by gently tapping your fingers on the axis of the lower leg. If you feel severe pain, then most likely the condyles are broken. Any movement in the injured knee will be accompanied by severe pain. It is very difficult to find a position in which relief will come. If you try to change the position of the leg, you will immediately feel a new attack of soreness.

In a medical institution, specialists conduct x-rays in two projections. Pictures will help to establish the presence of damage, as well as assess its nature and complexity. If there is a displaced injury, the specialist will be able to see how far the debris has displaced.

Fracture treatment

Let us immediately clarify that the treatment of fractures of this kind is carried out directly in a medical institution. If an injury with displacement is diagnosed, the patient is sent for a puncture, which is necessary to remove the blood that has entered the joint. Once the procedure is performed, a firm fixation of the injured limb is required. Plastering is performed over the entire surface of the leg, starting from the fingers and ending with the gluteal fold. For some time, the patient is strictly forbidden any load on the injured limb.

During the recovery of a limb after a fracture, various methods are used. Let's consider the main ones.

1. Reduction of the leg. It will be required in order to restore the consistency of the condyles in the articular cavities.
2. Strong fixation. We mentioned this method just above. The leg is in a cast until the injury heals. The timing of treatment in this case is sometimes very different.
3. In some cases, specialists may prescribe an early load on the damaged joint. In this case, the cast will be removed, and the patient will need to gently bend and unbend the knee.

It is impossible to unequivocally describe the tactics of treatment for injuries of this kind. Injuries are different, so the approach in each case may not be the same. Specialists choose the method of dealing with trauma, depending on its complexity and type. So, if an incomplete fracture or damage of lesser severity is noted, the limb is fixed in plaster for a period of days. As mentioned above, fixation is carried out from the upper thigh to the fingertips.

During treatment, the patient is strictly forbidden to walk even on crutches. The latter can be resolved no earlier than after the expiration of the leg fixation period. Also, specialists are able to use traction or simultaneous reduction.

For more severe cases, surgery is used. If there is a displaced fracture, the doctor will need to collect the fragments and set them in place. In this case, the period of stay of patients in a cast can greatly increase. It is strictly forbidden to refuse to fix the leg until the damaged area of ​​the leg is completely healed.

A fracture of the condyle of the tibia is a very serious and severe injury. It is impossible to name unambiguous terms of recovery in this case. Additional measures, including rehabilitation, are appointed exclusively by a specialist.

Fractures of the condyles of the tibia

As a result of a severe knee injury, fractures of the condyles of the tibia occur. This is a very serious violation and can even lead to the development of pain shock. And in case of untimely and incorrect treatment, it is the cause of disability. This type of fracture can be identified by X-ray examination. Treatment consists of skeletal traction and a plaster cast.

Causes of the fracture

Severe injuries with violation of the integrity of bone tissues occur as a result of falls, especially from a great height, also as a result of a blow. The danger is injury to the knee in a bent state. Then all the damage falls precisely on the condyles, which at the same time are in contact with the femur. When injured with abduction of the leg to the outside, the lateral edge suffers more. If, during a fall or impact, the leg is turned inward, then the medial condyle breaks.

How is it manifested?

A fracture of the lateral condyle of the tibia causes severe pain in the victim and can cause the development of traumatic shock.

Immediately after the injury, local pain appears at the site of injury. Puffiness develops, which eventually affects the entire limb. The skin becomes watery, an effusion forms on its surface. If there is a rupture of a large blood vessel in the knee, hemarthrosis is formed (accumulation of bloody fluid inside the joint bag). Also, with the naked eye, one can notice a valgus deformity of the lower leg with damage to the medial condyle of the femur, and a valgus deformity with an injury to the lateral edge. At the same time, the functional activity of the limb is almost completely disrupted, and unnatural lateral mobility in the knee joint is also detected.

A fracture of the condyle of the tibia is a source of unbearable pain and swelling.

Due to severe road traffic and other accidents, a compression fracture of the tibia causes breaking off of its condyles and their significant displacement. As a result, the knee is deformed, and the cartilage that provides movement in it is torn and can no longer perform its functions. Therefore, fractures of the condyles of the tibia often lead to disability of the patient, because when injured, serious violations occur with displacement of all structures of the knee.

Diagnosis and treatment

To diagnose the disease, an x-ray examination of the limb is performed in two projections. Computed tomography will help clarify the diagnosis. First aid in case of injury consists in anesthesia and immobilization of the limb. This will help prevent significant displacement of the fragments and injury to surrounding tissues. After being transported to a trauma hospital, a patient with fractures of the condyles of the tibia without displacement is subjected to a plaster cast. In the case of hemarthrosis, a puncture of the articular bag is indicated. If the patient has a significant amount of debris and the bone has already changed its location, then the skeletal traction procedure is indicated. The duration of treatment in this case is about 2 months.

Rehabilitation after a fracture of the condyle of the tibia

Patients with fractures of the tibia need a long period of rehabilitation. This is due to the fact that during a long course of treatment, muscle atrophy occurred, and the bones of the limb weakened.

First of all, the patient is shown physiotherapy, electrophoresis with anesthetic solutions will be useful. In addition, from the first day of completion of skeletal traction, the implementation of therapeutic exercises is indicated. They must be prescribed by a rehabilitation doctor. This will prevent secondary damage to the bone, help in the rehabilitation and restoration of joint tissue, and help damaged cartilage grow back.

Don't crunch!

treatment of joints and spine

• Diseases
  • Arothrosis
  • Arthritis
  • Bechterew's disease
  • Bursitis
  • Dysplasia
  • Sciatica
  • Myositis
  • Osteomyelitis
  • Osteoporosis
  • fracture
  • flat feet
  • Gout
  • Radiculitis
  • Rheumatism
  • Heel spur
  • Scoliosis
• joints
  • Knee
  • Brachial
  • Hip
  • Other joints
• Spine
  • Spine
  • Osteochondrosis
  • cervical
  • Thoracic
  • Lumbar
  • Hernias
• Treatment
  • Exercises
  • Operations
  • From the pain
• Other
  • muscles
  • Bundles

Fracture of the condyle of the tibia, terms of treatment

Fracture of the condyles of the tibia

In no case can you "reset" anything on your own

- a combination of a fracture of the ankles with a dislocation in the ankle joint;

Symptoms and diagnosis of tibial condyle fractures

A plaster cast is applied from the middle of the thigh to the tips of the toes.

Treatment of fractures of the tibial condyles

After 3-4 months, the patient's ability to work is fully restored.

An x-ray is performed to confirm the diagnosis. Pictures are taken in two projections: anteroposterior and lateral.

. As a rule, the patient can carry out the load on the injured leg on the next day after the operation. In most cases, the use of osteosynthesis for intra-articular fractures in the early stages allows you to restore the articular surfaces as accurately as possible, which eliminates the risk of early development of arthrosis of the damaged joint.​

In case of condylar fractures with displacement, reposition is performed and a plaster splint is applied for 6-7 weeks. If it is impossible to satisfactorily compare fragments, skeletal traction is performed for up to 2 months. Full load is allowed after 3 months from the moment of injury.​

Fracture of the condyles of the tibia

Fracture of the lower leg

. This should be done by a traumatologist after x-rays are taken.​

Fracture of the lower leg

Anatomy of the lower leg

A week after the plaster cast is applied, repeated x-rays are taken to check the position of the fragments.

fracture of the inner ankle

Classification of fractures of the lower leg

• The removal of skeletal traction and the application of a plaster splint is carried out after 4-6 weeks, when a callus is formed.
• The methods and duration of treatment depend on the type of fracture, the degree of displacement, and the number of fragments. These data become known after an X-ray examination has been carried out.​
• Osteosynthesis. Connection of bones

Surgical treatment is possible using screws, plates and the Ilizarov apparatus.

Fractures of the condyles of the tibia

- damage to the lateral sections of the upper part of the tibia. Refers to the number of intra-articular fractures, occurs with a direct blow, falling on the knee or on straightened legs. May be accompanied by displacement or depression of fragments. It is manifested by sharp pain, hemarthrosis, severe limitation of movements in the knee joint and impaired support. The diagnosis is clarified with the help of radiography, less often CT is used. Treatment tactics depend on the type of fracture, a plaster cast, skeletal traction and various surgical techniques can be used.

In the second type of fracture, a large fragment separates from the outer edge of the condyle and is usually displaced and deviated outward. Poor radiographs may suggest that there is only bone damage caused by a glancing blow from the side of the condyle. In fact, the fragment is split by the force of impact of the femoral condyle on the articular surface. An accurate radiograph reveals the presence of simultaneous damage to the central part of the condyle, usually in the form of crushing. The difference between these types of fractures is due to the position of the femoral condyle at the moment of impact on the condyle of the leg. In the first type of fracture, the entire tibial condyle is compressed by the corresponding articular surface of the femoral condyle. The impact force is distributed over a wide surface, causing neither splitting nor crushing of the condyle of the leg, but since downward displacement occurs, a secondary fracture of the neck of the fibula occurs. In the second type of fracture, the femur is at a sharper angle to the tibia. The rupture of the external and cruciate ligaments is so great that the femur is displaced to a greater extent and its sharp outer edge splits the condyle of the leg. When falling to the ground, the edge of this compact bone cuts like a blunt chisel into the tibia, breaking off a fragment from its edge and crushing the bone from the inside. Since the force of impact does not extend over a wide area, but is limited to a vertical line in the middle of the condyle of the tibia, the fibula remains intact. Even if the outward subluxation of the tibia, which can occur at the time of injury, is corrected, the depression in the head of the tibia remains, exactly corresponding in size and shape to the outer edge of the femoral condyle and thus clearly showing its origin. In the absence of immediate reduction of the subluxation, the traumatic role of the femoral condyle becomes even more obvious (Fig. 352, 353).

Treatment:

Stop bleeding, if any (with an open fracture)

Ankles when treatment was not carried out in a timely manner.

If no displacement occurs, and the fracture heals normally, the bandage is removed after 8-10 weeks.

Diaphyseal fractures of the leg bones

(associated with the tibia);

The plaster is removed after 2-4 months.

Treatment of fractures of the bones of the lower leg, in which there is no displacement

bruising and fever. Than it can be caused? And the pain in the leg is severe.

A tibial shaft fracture is the result of direct or indirect trauma. If the interosseous membrane remains intact, there is no displacement of fragments along the length. Angular and width offset possible.​

Fracture of the condyles of the tibia - intra-articular damage to the lateral parts of the upper epiphysis of the tibia. It occurs in people of any age and gender. It occurs as a result of a direct blow to the area of ​​the knee joint, a fall on the knee or on straightened legs (in the latter case, as a rule, fractures are formed with the impression of fragments). Sometimes this type of tibial fracture is observed in a road traffic injury due to a knee hit on the front panel. Fractures of the lateral condyle are most often diagnosed, fractures of both condyles are the second most common and fractures of the internal condyle are the third.

​Fig. 352. Fracture of the external condyle of the tibia. Avulsion of the cruciate ligament. The mechanism of splitting and fragmentation of the condyle of the tibia is quite clear when the edge of the condyle of the femur is wedged.

Ankle fractures

. Depending on the intensity of bleeding, a tight bandage or tourniquet can be applied.

• Deforming osteoarthritis
• Indications for surgical treatment of ankle fractures
• fracture of the lateral malleolus

. If a large artery is damaged, there is a risk of losing the entire part of the limb below the injury.

Usually, the doctor prescribes the first control image after applying skeletal traction on the 3rd day. If there is no displacement, treatment is continued according to the plan described above. If the bone fragments are displaced, the traumatologist usually prescribes surgical treatment.

Treatment

Fracture of the tibia. Fracture complications. Diagnosis and treatment of tibial fractures

Treatment of tibial fractures

Physician's answer: The patient is concerned about pain and swelling in the area of ​​injury. The tibia is deformed. Foot support is not possible. For confirmation, x-rays are taken in two projections. Fractures can be complete or incomplete, with or without displacement. Incomplete injuries include cartilage crush, limited depressions and cracks. Complete damage is accompanied by separation of the entire condyle or part of it. Fractures of the condyles can be combined with damage to the ligaments of the knee joint, damage to the meniscus, fractures of the fibula and intercondylar eminence. Fractures of other limb bones, TBI, fractures of the pelvis and spine, blunt trauma to the abdomen, and injury to the chest can also be detected in motor vehicle accidents and falls from a height. 353. A picture during reposition using a compression clamp (see Fig. 352). The victim should be taken to the trauma center on a stretcher as soon as possible. . This is a degenerative disease accompanied by the destruction of cartilage and most often occurs when damage to blood vessels and nerves. It manifests itself in the form of pain, crunching during movements in the joint, limitation of mobility.

​:​​(associated with the fibula).​​Nerve damage​

It might be interesting

• Types of surgical treatment for fractures of the bodies of the tibia and fibula

User Questions about Tibia Fracture

We recommend that you see a doctor. Do not self-medicate on the Internet. Anesthetize the fracture site. When the fragments are displaced, reposition is carried out, followed by the imposition of a plaster splint for a period of 2 months. With interposition of soft tissues (wedging of tissues between fragments), an operation is necessary.

At the time of the injury, there is a sharp pain in the knee. The knee is enlarged in volume, with a fracture of the internal condyle, varus deformity can be detected, with a fracture of the external - valgus. Movement and support are sharply limited. Pathological mobility is observed during lateral movements in the joint. Gently pressing on the condyles with one finger, you can usually clearly define the zone of maximum pain. There is a pronounced hemarthrosis, which sometimes causes a sharp expansion of the joint and local circulatory disorders. Without a clear understanding of the mechanism of injury, it is difficult to accurately determine the severity of the damage. Ligaments are completely severed. The outer meniscus is damaged and pressed into the condyle of the tibia. The articular surface is seriously damaged. Wedging of the fragment into the base of the tibial condyle may interfere with reposition. Individual fragments may be deprived of blood supply. Avascular necrosis leads to degeneration of the overlying cartilage. There is a danger of constant instability of the joint and the development of degenerative arthritis. However, immediate arthrodesis is indicated only in rare cases. The prognosis must be made with great caution, but precise repositioning, complete immobilization, and muscle exercise will usually restore joint function.​

A blow to the outside of an extended knee puts the joint in forced abduction, tears the medial patellar ligament, and can stretch the cruciate ligament. A more severe injury, such as being struck by a car or a heavy fall on the outside of the limb, causes more hallux valgus in addition to rupture of the lateral and cruciate ligaments and fracture of the lateral condyle of the tibia. The main task of the doctor is to establish whether in this case there is an isolated fracture of the lateral condyle of the tibia due to a direct injury to it or as a result of severe valgus tensions causing rupture of the ligaments, and then splitting or crushing of the condyle, or there was first a ligament rupture, and then - compression or fracture of the lateral condyle due to wedging of bone fragments. Treatment of damaged soft tissues is no less important than the treatment of the fracture itself. Massage and early exercise, sometimes recommended, are dangerous as they complicate the X-shaped deformity created by uncorrected depression of the tibial condyle, non-union of torn ligaments, and lateral instability of the knee joint. The main point of the intervention should be the correction of hallux valgus and the provision of immobilization for at least 10 weeks. Even with sufficient immobilization, ligaments sometimes fuse with elongation and some degree of buckling is inevitable. In addition, the articular surface of the lower leg is usually damaged, which causes the phenomena of degenerative arthritis. The future function of the joint depends on the condition of the muscles. If the protection of the well-twitching muscle joint is not restored, then when turning and loading the body, stretching of weak ligaments, damage to the joint and worsening of the arthritic condition will occur. Wearing a splint does not improve the condition. The pain may be so severe that arthrodesis may be required. On the other hand, if the tone and volume of the thigh muscles are maintained by active exercises of the quadriceps, starting from the next day after injury, then the joint is provided with proper protection. A slight violation of the ligamentous apparatus is not of great importance. The joint is protected by muscles from the action of the load and arthritis does not progress (Fig. 350).

Contracture fails to eliminate the displacement of fragments in a closed way;

depending on the mechanism of fracture. It leads to a violation of the movements of the foot, gait.

. The doctor injects an anesthetic solution. Doctor's answer:

A fracture of the diaphysis of the fibula develops as a result of a direct blow to the lower leg from the outside. The injury is accompanied by pain at the fracture site and slight swelling. The patient retains the ability to lean on the leg. In contrast to a contusion of the tibia, with a fibula fracture, pain appears with lateral compression of the tibia away from the injury site. An x-ray is taken to confirm. The patient is given a plaster splint for 3-4 weeks.

The main method of instrumental diagnostics is radiography of the knee joint. X-rays are performed in two projections. In the vast majority of cases, this will make it possible to reliably establish not only the fact of the presence of fractures, but also the nature of the displacement of fragments. With ambiguous results of radiography, the patient is referred for a CT scan of the joint. If concomitant damage to soft tissue structures (ligaments or meniscus) is suspected, an MRI of the knee joint is prescribed. Sometimes fractures of the condyles are accompanied by compression of the nerves and blood vessels, if damage to the neurovascular bundle is suspected (damage to the vessel and nerve damage), consultations of a vascular surgeon and a neurosurgeon are prescribed.

On fig. 351 shows a typical compression fracture of the lateral condyle. The fracture line enters the joint in the region of the intercondylar eminence. The articular surface is smooth and unchanged. The condyle is wedged from the outer and rear sides, causing the formation of a deformity in the form of genu val - gum and limitation of extension. There is a crushed wedged fracture of the neck of the fibula.

Diagnostics

Treatment

• With ordinary fresh injuries, an arthrotomy is performed. Fragments lying freely in the joint cavity are removed. Large fragments are set and fixed with a screw, nail, knitting needles or special L- and T-shaped support plates. With multi-comminuted injuries and open fractures, external osteosynthesis is performed using the Ilizarov apparatus.
• Active exercises of the quadriceps muscle are immediately prescribed, consisting in its rhythmic contraction and relaxation. After a few days, the patient is already able to raise the limb in a plaster cast, overcoming gravity and even a load suspended from the ankle joint. Weight-bearing of the limb can be allowed after 5-6 weeks only if a new cast is applied. After 10 weeks, the plaster bandage is removed and an elastic bandage is applied to the lower leg and to the area of ​​the knee joint to prevent swelling. Movement in the knee joint is restored with active exercises, supplemented if necessary, after a few months with massage, but by no means passive stretching.
• The condyle is split by the edge of the femoral condyle and the marginal fragment is displaced. In both cases, damage to the internal, and sometimes the cruciate ligaments, is possible.
• - when the fracture does not heal due to the fact that a fragment of tissue is infringed between the fragments.
• . From the very first days, they begin to move in the ankle joint - flexion towards the sole. On the 5-7th day, a more active gymnastics complex begins.
• - when turning the foot outward.

• If you suspect a fracture of the bones of the lower leg, you should immediately call the ambulance team, which will take the victim to the emergency room.
• Reliance on an injured leg

Complications of fractures of the bodies of the bones of the lower leg:

• Limb deformity load can be increased after 6-12 weeks, depending on the type of fracture;
• ​usually carried out after a week.​​It is normal for pain to persist after a bone fracture. What is baking is not clear. Consult a traumatologist.​
• isolated fractures of the inner and outer ankle; After osteosynthesis, the wound is sutured in layers and drained. With stable fixation, immobilization in the postoperative period is not required. The drainage is removed for 3-4 days, then exercise therapy with passive movements is started to prevent the development of post-traumatic contracture of the joint. Assign thermal procedures. After reducing pain, they move on to active development of the joint. A light axial load on the limb with conventional osteosynthesis is allowed after 3-3.5 months, during bone grafting - after 3.5-4 months. Full support on the leg is possible after 4-4.5 months.​
• Probably the best treatment is to restore the correct position of the marginal fragment with its viable articular cartilage and leave avascular fragments with necrotic cartilage embedded in the tibial condyle. The central crater, from where these fragments were displaced, is filled with fibrous scar tissue and remnants of the outer meniscus. It supports the function of the knee joint, surrounded by viable articular cartilage, which then bears the weight of the body. Traction is carried out on the table, correcting the hallux valgus. The reduction of the marginal fragment requires strong compression. Loose bone fragments wedged into the angle between the marginal fragment and the tibial condyle must be crushed, which cannot be achieved by manual compression. The Thomas apparatus slips off the bone, and a special clamp with cheeks in the shape of the condyle has to be used (see Fig. 353). The correctness of the reduction made is checked by an x-ray, after which a plaster cast is applied for a period of at least 10 weeks. Immediately begin active exercises of the quadriceps muscle until the movement in the knee joint is restored.​
• . The patient is allowed to get up on the 4-5th day after the operation. A further program to increase the load on the leg is developed individually. Severe pain.
• . Occurs with untimely and incorrect surgical treatment of fractures. After 15 days, the patient can get out of bed and move around with crutches;
• Rehabilitation treatment starts to hurt and swell a lot

Bimalleolar fractures (fractures of both ankles); Prognosis with adequate comparison of fragments, adherence to doctor's recommendations and timing of treatment is usually satisfactory. The lack of complete anatomical reposition, as well as premature axial load on the joint, can provoke subsidence of the fragment, which causes the formation of valgus or varus deformity of the limb, followed by the development of progressive post-traumatic arthrosis. ​

• In some cases, the condyle is so fractured that manual repositioning becomes impossible. Rice. 354 and 355 illustrate a similar case.​
• ensure immobilization of the limb in a plaster cast for a sufficiently long time, until the fracture and torn ligaments grow together;

Ankle fractures

Causes of Ankle Fractures

• Repeat x-rays
• Impossibility of movements in the ankle joint due to pain and swelling.
• Formation of a false joint

Types of ankle fractures

Signs of an ankle fracture

• Full recovery
• It is necessary to take x-rays of the damaged joint and come to our center for a consultation.
• Any ankle fractures can be accompanied by ligament rupture, displacement of fragments and subluxation of the foot (fracture dislocations), however, more often such injuries are observed with two- and three-malleolar fractures. A fracture of the lateral malleolus is characterized by medial subluxation of the foot, while a fracture of the medial malleolus is characterized by an outward subluxation of the foot.
• Fractures of the lower leg bones account for 10% of the total number of fractures. The course, methods and terms of treatment depend on the level and extent of damage and differ in fractures of the leg bones of various localization.

It does not matter the type of fracture, nor the use of manual or operative reduction. To do this, you can use boards, pieces of reinforcement - wrap the injured leg to them with a bandage or a long strip of fabric. It is advisable to find an object in the shape of the letter "G", with which it will be possible to fix both the knee and the foot. In the absence of improvised means, you can bandage the injured leg to a healthy one.

• ​Removing spokes, screws and plates​
• Development of infection after surgery

Removal of rods, screws and plates is carried out after a month, depending on the type, severity of the fracture, the chosen method of fixation, occurs after 3-4 months. posted to work. After 3 months, the tibia fractured again without displacement (there was no injury, the bone just cracked while walking). They put on a lanyard. How long to walk with her? Why did the bone crack and how long will it heal now?

• The ankle joint is swollen, sharply painful. Reliance on the leg is difficult, with fractures and dislocations it is impossible. With dislocation fractures, there is a deviation of the foot in the corresponding direction, with Pott-Desto fractures - flexion of the foot to the plantar side. To confirm the diagnosis, x-rays are performed in two, sometimes in three projections.
• Lower leg - part of the skeleton between the thigh and foot, consisting of two tubular bones (tibia and fibula). The main load is borne by the larger tibia. The condyles (protrusions at the top of the tibia) connect to the femur to form the lower articular surface of the knee joint. With its lower part, the tibia articulates with the talus, forming the ankle joint.
• ​Fig. 355. Despite osteoarthritis due to avascular necrosis of separated fragments, the function was preserved and the painful symptoms were negligible. The patient, 10 years after the injury, continued to work in agriculture.
• The essence of success lies in restoring the tone of the thigh muscles.
• Take off your shoes

. Usually carried out after 8-12 months. Symptoms that a traumatologist reveals during an examination of the victim

• Fixation of fragments with screws

Treatment of fractures of the bones of the lower leg, in which the displacement of fragments occurs. Doctor's answer:

• Anesthesia of the fracture, reposition, application of a plaster splint. In case of a fracture of one ankle without displacement, the immobilization period is 4 weeks, with two-malleolar fractures (including those with subluxation of the foot) - 8 weeks, with Pott-Desto fractures and ruptures of the tibiofibular syndesmosis - 12 weeks. The operation is indicated when it is impossible to compare bone fragments and interposition of soft tissues. The fibula is located on the outside, increasing the stability and strength of the lower leg. Both bones of the lower leg are connected to each other (above - with the help of a common articulation, in the middle part - through the interosseous membrane, below - with the help of ligaments). At the lower ends of both bones of the lower leg there are protrusions (ankles) that cover the ankle joint on both sides and give it transverse stability.
• The marginal fragment is relatively small, and the rest of the condyle is striated. Separate fragments are inverted and wedged between the anterior surface of the thigh and lower leg, others are pressed into the tibia. Without surgery, in such a case, fibrous ankylosis of the joint can be expected, but even with such a fracture, one should strive to avoid arthrodesis. Complete immobility in the knee joint is more important than in any other joint of the lower limb. If the possibility of arthroplasty with complete ankylosis of the knee joint is not excluded, then the problem of treating a comminuted fracture of the condyle cannot be considered insoluble. The joint is opened from the outside, the meniscus is removed and the fragments are set in a normal position. Internal fixation of fragments is not required. Immobilization lasts 3 months. Assign exercises for the quadriceps muscle. They should be performed every hour for 5 minutes throughout the day. Despite avascular necrosis and degenerative arthritis, restoration of muscle strength prevents the joint from sprains and twisting. Quadriceps exercises can be started the day after injury, repeating them for 5 minutes per hour throughout the day until the cast is removed. 3 months after injury, the muscles should be as strong as on a healthy limb. The use of a splint on the knee joint is not required. It is impossible to justify the neglect of natural protective mechanisms - one's own muscles, allowing them to weaken, in order to then resort to imperfect methods of artificial mechanical protection in the form of a splint. The apparatus diverts the attention of the surgeon and the patient from their immediate task of developing the muscles and may even lead to great relaxation of the latter. Many types of fractures of the lateral condyle of the tibia are described in the literature, but only the following two types are of clinical importance, characterized by different etiology, radiological picture, treatment technique and prognosis:
• . With a fracture, swelling increases, so later it will be much more difficult to undress the victim. Massage, physiotherapy, ozokerite therapy
• ​:​​Possible complications after using the Ilizarov apparatus​
• ​.​​:​

These signs are pronounced if a fracture of the tibia has occurred. When a fibula is fractured, there is usually only pain and slight swelling. This injury is more difficult to identify. In children, the bones of the lower leg can break like a "green twig". In childhood, there is less calcium in the bones, they are more flexible. Fragments are securely held by the periosteum, no displacement occurs.​​Currently, the treatment of a tibial fracture​

• Depending on the localization, traumatology distinguishes: Operative reposition is possible only with fractures not older than 10 days. Sometimes surgery is not possible due to injuries, infection, or other complications that require long-term treatment. Under such circumstances, the surgeon must ensure optimal position of the limb by manual reduction. Often there is an unexpected recovery of joint function. But in case of fragmentation of the articular surfaces, painful movements or the development of fibrous ankylosis, a decision should be made on the production of arthroplasty or arthrodesis. Arthroplasty of load-bearing lower limb joints does not give good results. Arthrodesis is more reliable. With severe ankylosing of the knee joint, the limb is stable and painless, and the subject can perform even heavy work. But still, dysfunction after arthrodesis of the knee is more significant than after arthrodesis in the hip or ankle joint, and a number of professions require some, at least limited, mobility. For example, one cannot imagine a pilot after an arthrodesis operation, whereas after an arthroplasty operation performed by the author on one pilot, the latter continued long-distance flights across the Atlantic and Pacific oceans. This or that decision must be made taking into account the profession of the victim.​
• compression fracture without fragmentation and damage to the articular surface; this type of fracture can be reduced by manual reduction. Ligament damage with it is minimal, the prognosis is good; Give the victim an anesthetic
• . Assigned individually. Severe pain when pressing on the injured ankle.​
• ​:​​They use special screws made of surgical steel, with which the fragments are fixed to each other.​

Complications of ankle fractures

• Anesthesia at the fracture site In the emergency room, the traumatologist examines the victim. It defines the following symptoms:
• usually done through surgery. Due to the anatomical feature of the structure of the lower leg, fractures of the bones of the lower leg in its upper part (fractures of the neck and head of the fibula, fractures of the tuberosity and condyles of the tibia);
• The most reliable is the Campbell operation, in which one femoral condyle is removed with the formation of a corresponding depression in the tibia. In relatively early cases of comminuted fractures of the tibial condyle during arthroplasty, it may turn out that the articular surfaces of the thigh are not damaged. Then there may be a desire to perform arthroplasty with the removal of only part of the tibia without removing the healthy surface of the articular cartilage of the femur. But such an approach would be erroneous, and the results of such an operation are less satisfactory than after the described arthroplasty. A well-functioning joint with a single condyle, providing mobility and stability, can only be formed if the condyle of the femur and tibia is removed. The distance between the cut surfaces should be at least 1.25-1.5 comminuted fracture with separation of the marginal (marginal) fragment and severe damage to the articular surface.
• . If someone nearby knows how to give injections, it is better to inject the medicine intramuscularly. The arriving doctor must be told which drug was administered, when and at what dose. Indications for the application of the Ilizarov apparatus for fractures of the ankles

First aid for suspected fracture of the leg bones

FRACTURES OF THE EXTERNAL TIBIRAL CONDYLLE

. To do this, they take the foot with one hand by the heel, and with the other by the fingers, and gently pull, straightening the leg.

multiple fracture The diagnosis is confirmed after an x-ray. The fracture is clearly visible on the pictures. ​ Curvature of the leg, violation of the fusion of fragments due to insufficient fixation, loosening of the nuts. They use special steel plates with holes that are fixed to the bone with screws. Such designs should not be used in young children, as they can damage the periosteum and disrupt bone growth.. A steel needle is passed through the calcaneus, to which a bracket is attached and a load is suspended from it. The patient is placed with a suspended load on the bed on a special tire.

1. fractures of the bones of the leg
2. Fractures of the bones of the lower leg in the upper and lower sections belong to the group of intra- or periarticular fractures.
3. ​Operation Brittain is theoretically rational and practically applicable. Articular cartilage is removed simultaneously from the thigh and lower leg. Accurate alignment of the limb axis must be achieved. Two grafts taken from the tibia are passed through the joint from the tibia to the femur so that they intersect in two planes (this achieves excellent stability and the limb is immobilized in a plaster cast until the fracture is completely consolidated), or the surfaces are fixed with a three-blade nail, and the gaps fill with spongy fragments.

The articular surfaces themselves are not damaged, and thus there is no threat of developing arthritis. Damage to the ligamentous apparatus is less severe than in the second type of fracture. Cruciate ligaments can avoid damage altogether. Displacement can be corrected by traction and manipulation. With fresh fractures, surgery is unnecessary. The prognosis is good. After correcting the valgus deformity and the level of the condyle, maintaining the tone of the femoral muscles allows you to count on good results (Fig. 351). Apply cold to the fracture site

1. Ankle fractures are usually treated without surgery.
2. tucking the foot in or out with simultaneous load along the axis of the limb, as a rule, by its own body weight;

Treatment with the Ilizarov apparatus

Compression fracture of the condyle of the tibia

Periodic x-rays

- This is a characteristic crunch (as if the bubbles burst), which occurs when the fragments are displaced. Determined by pressing in the fracture area.​

in hospitals, skeletal traction for the calcaneus is used. This method is used for preoperative preparation and improvement of the condition of the skin on the damaged lower leg. Usually occurs when falling from a height. In younger patients, they are more often split, in older patients - depressed. Allocate fractures of the internal and external condyles.​​​Fig. 351. Fracture of the external condyle of the tibia. View to. It can be a towel soaked in cold water, an ice pack.

Comminuted fracture of the condyle of the tibia

Combination of a fracture of the ankles with fractures of the bodies of the bones of the lower leg

A blow to the ankle (for example, by a moving car);

In adults, the operation can be performed under local anesthesia, in children - only under general anesthesia. Knitting needles are passed through the bones of the lower leg in certain places, on which a metal structure is assembled from steel rings using threaded rods, bolts and nuts.

Treatment of a compression fracture of the lateral condyle of the tibia

. According to the pictures, the doctor controls the process of education

Manual reposition

In our center, traumatologists and orthopedists use the most modern methods of conservative and surgical treatment of tibial fractures. The use of the latest methods of bone and intramedullary osteosynthesis The patient complains of pain and swelling in the area of ​​injury. The knee joint is enlarged in volume as a result of hemarthrosis (accumulation of blood). A fracture of the external condyle is accompanied by an outward rotation of the lower leg, a fracture of the internal condyle is accompanied by an inward deviation of the lower leg. Movement in the joint is sharply painful, limited. Support on the leg is impossible or difficult. For confirmation, X-ray, MRI of the knee joint is performed.​

Follow-up treatment

Treatment of comminuted fractures of the tibial condyle

Manual reposition

Avoid rough movements, do not stand on an injured leg

Operative reposition

The doctor performs anesthesia - injects the fracture site with an anesthetic solution.

Fall on the ankle area of ​​a heavy object.

A full load on the leg can be given as early as possible, since the Ilizarov apparatus reliably fixes bone fragments;

Arthroplasty and arthrodesis

By pressing on the bones of the lower leg or on the heel.

Knee Arthroplasty

Allows to accelerate the recovery and rehabilitation of patients with fractures of the leg bones A fracture of the tibia is anesthetized, if necessary, a puncture of the joint is performed. In case of fracture of the condyles without displacement, a plaster cast is applied for 1 month. At the end of immobilization, physiotherapy and physiotherapy exercises are prescribed. Full load is allowed after 2 months from the moment of injury.​​Bone fractures and joint damage (translated from English). - M.: Medicine, 1972. - p.672.​

Arthrodesis of the knee joint

. This can lead to even greater displacement of fragments, damage to blood vessels and nerves, and, ultimately, to the loss of a limb.

fracture dislocation Then a closed reposition is carried out - the traumatologist eliminates the displacement of the ankles.

Depending on which ankle is broken

Limb injuries are especially common in winter - due to icing, the number of unsuccessful falls increases dramatically. Joint injuries are the most severe. Bringing a lot of inconvenience, they are difficult to cure and heal for a long time.

Fracture of the condyle of the tibia, compression or impression (inside the joint) is one of the most common. It can happen when the victim falls with extended limbs or under other circumstances.

Fracture of the condyles of the tibia - damage to the thickening at its end. In this place, the attachment of ligaments with muscles occurs. There are two of them - internal (medial) and external (lateral). The condyles are quite fragile because they are covered with cartilage. This tissue differs from bone elasticity, it is not so resistant to external influences.

A comminuted fracture of the condyle of the tibia is a consequence of its displacement. When a person falls, they are sharply squeezed. A dense layer of the metaphysis is pressed into the epiphyseal spongy composition. The epiphysis is divided into a couple of parts, breaking the condyles.

You can determine which part is broken by external signs:

• the lower leg moved outward - there was a fracture of the internal condyle of the tibia due to displacement;
• the lower leg moved inward - the internal condyle was damaged.

Complete breaks are also isolated when the condyle is separated. With an incomplete fracture, indentation or cracks are likely - but without separation. Also, a fracture of the fibula or tibia with an affected condyle may be with or without displacement.

Often such injuries are accompanied by accompanying troubles:

• fibula injury;
• ligamentous and meniscal tears, ruptures;
• fractures of the elevation between the condyles.

Symptoms and Diagnosis

Fractures of the condyles of the tibia have characteristic symptoms:

• pain;
• joint dysfunction;
• hemoarthritis;
• specific deformation;
• lateral movement of the knee joint.

Pain does not always depend on the severity of the injury. A displaced fracture of the lateral condyle of the tibia may not be felt. Therefore, the damaged area should be probed by a specialist. So the doctor determines the presence of pain in certain points. On your own, you can simply put pressure on the knee joint. If the sensations are unpleasant, it is better to visit a traumatologist.

Hemoarthrosis, sometimes reaching a significant size, is also characteristic of such injuries. The fact is that the joint increases in volume, while violating blood circulation. In this case, the doctor sends the victim to a puncture, which consists in getting rid of the accumulated blood.

Suspicions of a fracture of the medial or lateral condyle of the tibia may also appear after tapping the axis of the leg with the fingers. If the pain is severe, then they are most likely broken. It will be very painful with every movement of the injured knee. A pose in which it will be easier is not easy to find. Any change in the position of the leg leads to new pain attacks.

Treatment

A fracture of the condyles or intercondylar eminence of the tibia is treated, taking into account the specifics of the injury. First, the fragments are set - if any. Then they are fixed until the onset of total consolidation. An ice bag is applied to the limb.

If there is a crack or incomplete fracture of the internal or external condyle of the tibia, plaster splints provide immobilization - from the upper third of the thigh to the fingers. It is set for a month.

In the hospital, traction is done, glue or skeletal, as well as one-stage reduction by hands, then fixing it at constant traction. When a small fracture of the condyle of the tibia occurs with an accompanying displacement, it is pulled out by the shin using the adhesive method. A pair of adjusting side loops is used.

With a marginal fracture of the lateral condyle of the tibia, the lateral loop is set so as to direct the traction outwards from the inside. This eliminates the typical deformity, and the displaced condyle is reduced and held in the correct position.

If a fracture occurs with a strong displacement, subluxation or dislocation of one or both condyles, it is necessary to perform skeletal traction. For this, an ankle clamp is used.

To approach one to the other condyles that have gone to the sides, the apparatus of the N.P. system will do. Novachenko or side loops. Sometimes at the same time it is necessary to manually set the displaced fragments. Anesthesia is used:

• in place;
• into the spinal cord;
• general.

In the case of traction, in the absence of acute pain, intensive movements can be switched over after a few days. Early activity contributes to the achievement of better reduction of fragments, the creation of congruence of the surfaces of the joints.

Adhesive, as well as skeletal, traction is usually eliminated a month after installation. After skeletal for half a month, an additional adhesive traction is put. When the traction is finally removed, the victim can stand on his feet without putting much strain on the injured leg. It will be possible to fully activate it no earlier than in another month.

Surgery

The operation is necessary if:

• reduction of fragments did not help;
• closed reposition with further traction did not help;
• a fragment was infringed inside the joint;
• there is a fracture between the condyles;
• fragments are compressed brightly;
• blood vessels and nerves were damaged.

Even skeletal traction does not always help, which usually provides the best comparison of fragments. So there are more indications for operations, doctors give such a recommendation to victims more often.

If the lesions are fresh, an arthrotomy is performed. At the same time, the smallest particles present in the joint are removed absolutely, and large ones are subjected to fixation:

• carnation;
• knitting needles;
• screw;
• special plates for support.

In open fractures or with multiple fragments, external osteosynthesis is performed using the Ilizarov apparatus. The osteoplastic procedure according to Sitenko is carried out if:

• chronic closed fracture of the internal or external condyle;
• subsidence of the condyles - secondary, due to intense load on the injured leg;
• fresh trauma with high compression.

The joint is opened and then an osteotomy is performed. As a result, the upper part of the affected condyle rises to the height of the second condyle. Articular areas must be in a single plane. The resulting void is filled with a wedge. It is prepared in advance from bone - auto- or heterogeneous. The collected fragments are fixed with a plate and screws.

Then the wound is sutured, drainage is carried out. After the operation, immobilization is carried out. Drainage is removed after three to five days.

It is necessary to perform exercise therapy based on passive exercises to prevent articular contracture. Thermal procedures are shown. When the pain subsides, you can develop the affected joint.

After conventional osteosynthesis, a light load along the axis is allowed three months later, after bone grafting - after four months. It will be possible to rely entirely on the limb in five months. The results of the treatment will be positive if it is carried out correctly, and the patient follows all the recommendations of the doctor.

Complications

A compression or non-compression fracture of the tibial condyle requires a competent approach to treatment, following the recommendations. Diagnosis of fractures and intervention of doctors are made as early as possible. Experienced doctors should deal with trauma.

Otherwise, serious consequences are possible:

• prolonged immobilization;
• degenerative arthrosis;
• angular deformities of the limb;
• infection of the wound with infection during surgery.