Tibial condyle fracture

　　The etiology analysis of this disease includes the following situations:

　　1. The upper end of the adult tibia is composed of cancellous bone on both sides, with no strong support below the lateral edge, making it a weak point prone to fractures. Direct and indirect external forces can cause tibial condyle fractures. Direct external force is commonly caused by the impact of a car's bumper. Indirect external force is often due to high-altitude falls where both feet land, compressing the tibial condyle. Or, inversion and eversion stresses can cause fractures with associated knee ligament injuries. Due to the protection of the contralateral lower limb, inversion stress is not easy to occur, so external condyle fractures are more common than internal condyle fractures.

　　Vertical compressive force often causes T-shaped or Y-shaped bicompartmental fractures. Twisting stress can also lead to tibial condyle fractures with ligament injuries.

　　When the knee joint is injured in a straightened position, it often causes complete unicompartmental fracture, while in a flexed position, the fracture is often limited to the middle or posterior part of the tibial condyle. An external rotation stress injury to the knee joint in a flexed position with the lower leg can cause a fracture of the anterior part of the tibial external condyle. Conversely, an internal rotation stress can cause a fracture of the anterior part of the internal condyle.

　　What diseases can be concurrent with tibial condyle fracture?

　　Tibial condyle fracture is an intra-articular fracture, with the fracture extending to the articular surface of the proximal tibia. The main complications include genu varum deformity and traumatic arthritis. In some severe cases, there may be varying degrees of joint effusion with widespread or localized swelling. Complications such as meniscal and ligament injuries may also occur, making tibial condyle fracture prone to cause functional impairment of the knee joint. Other non-infectious complications include non-union, deep vein thrombosis, heterotopic ossification leading to joint stiffness, etc., all of which require active treatment.

　　The knee joint has a serious history of trauma, with pain and tenderness in the knee joint after injury, functional impairment, not only the affected lower leg cannot bear weight, but also cannot actively extend and flex, in severe cases, there may be varying degrees of joint effusion, with widespread or localized swelling, and varying degrees of deformity may also occur. External condyle fractures can lead to genu varum deformity, and comminuted fractures can cause palpable crepitus. Swelling and tenderness at the collateral ligament site indicate collateral ligament injury, and the drawer test should be performed to exclude cruciate ligament injury.

　　The main prevention of this disease is postoperative prevention, and attention should be paid to the following two points:

　　Early activity can avoid joint adhesions caused by activity disorders and pain, and better shape the damaged joint surface. Joint activity should be started as soon as possible, and the more severe the injury, the earlier the joint activity is needed.

　　Accurate reduction and maintaining the position of fracture reduction can prevent joint instability and deformity.

　　X-ray examination:For patients suspected of having a proximal tibial fracture, it is necessary to take an anteroposterior and lateral X-ray image to understand the degree and characteristics of the fracture, and it is very important to take a oblique view image to show the outline of the posterior tibial condyle involved. Generally, take X-ray images of the proximal tibia and fibula and the knee joint in anteroposterior and lateral positions, as well as the oblique views of both sides, and the anteroposterior view inclined 10° to 15° to the foot can better show the platform. Stress X-ray films can show injuries or tears of the collateral ligament and cruciate ligament.

　　1. Treatment method:Take an appropriate amount of red bean and decoct it, add a little red sugar, and take it warm. This formula is suitable for the blood circulation and blood stasis stage.

　　2. Treatment method:1000 grams of pork bone, 250 grams of soybeans, add water and simmer slowly until tender, add salt and ginger for seasoning, and eat it as food.

　　3. Treatment method:One set of pork spine bone, wash clean, 120 grams of red dates, 90 grams of lotus seeds, 9 grams of xiangxiang and shenggancao, add water and simmer slowly until tender, add ginger and salt for seasoning, and drink it in several doses.

　　4. Treatment method:Two fresh crabs, take the meat (with the yolk), when the rice porridge is cooked, add the crab meat, and then add appropriate ginger, vinegar, and soy sauce for consumption. Take it regularly.

　　Precautions before the treatment of tibial condyle fracture:

　　First, to maximize the recovery of knee function:

　　To avoid joint instability, deformity, stiffness, and pain, appropriate treatment methods should be adopted according to the original fracture situation of the proximal tibia. Pay attention to two principles.

　　1. Early activity:It can avoid joint adhesions caused by activity disorders and pain, and better shape the damaged joint surface. Joint activity should be started as soon as possible, and the more severe the injury, the earlier the joint activity is needed.

　　2. Accurate reduction:Maintaining the position of fracture reduction can prevent joint instability and deformity. However, it is not mandatory to achieve anatomical reduction. To maintain the reduction position while allowing early activity, traction is a better method.

　　Second, there are several treatment methods:

　　1. Cast brace fixation:For splintered fractures without or with slight displacement, or compressed fractures not exceeding 1cm. For external sprains of grade I and II, and internal sprains and vertical injuries with slight displacement, the cast brace is fixed for 3 to 4 weeks, and early quadriceps exercises should be started. Sometimes, for external sprains of grade III and IV, the position can be temporarily restored by manual manipulation or levering before being fixed with a cast brace to maintain the复位 position. After the cast brace is removed and the knee joint is exercised for the first time, the patient should not bear weight for walking earlier than 8 weeks.

　　2. Traction Treatment:Traction treatment is a commonly used and effective method for proximal tibial fractures, and it is advisable to use tibial or calcaneal traction for internal and external rotation injuries with large vertical displacement. The affected limb should be placed on a Thomas frame, and the lower leg should be placed on the Pearson frame attached to the Thomas frame, which should be consistent with the flexion and extension axis of the knee joint. Use the attachment frame to exercise the flexion and extension of the knee joint. At the same time, according to the characteristics of the fracture, use the attachment frame to place the lower leg in an inward or outward position. After the initial connection of the fracture, change the sliding traction to fixed traction and increase the range of knee joint functional exercise. After 6 weeks, the traction is removed, but weight-bearing should be after the solid healing of the fracture to avoid deformation.

　　This traction combined with early activity treatment method makes the re-shaping of the tibial condyle shape during the fracture healing process, and in the joint arthrography after fracture healing, or in the case of surgical exploration or arthroscopic observation due to other reasons, even for severe comminuted fractures, the re-shaped joint surface is surprisingly smooth.

　　3. Surgical Treatment:For unicompartmental or bicompartmental fractures, bone bolts can be used for internal fixation. For smaller split fractures, cancellous bone screws can be used for internal fixation, and for comminuted multiple-fracture fractures, multiple screws can be used for internal fixation in different directions. For compressed fractures, the fracture can be reduced by prying, and cancellous bone or bone cement can be used to fill in bone defects. For patients with ligament injuries, in addition to treating the fracture, repairs should be made according to the condition of the injury.

　　For tibial condyle fractures, the excellent rate of conservative treatment at Beijing Jishuitan Hospital can reach 77%, while the excellent rate of surgical treatment is only 45%. This shows that non-surgical treatment combined with early functional exercise is still the main treatment method for tibial condyle fractures. As long as it is properly handled, a good excellent rate can be achieved.