Closed fracture of the medial condyle of the right tibia. How long does it take to treat a fracture of the tibial condyle? Complications of tibial condyle fractures

The content of the article

Among fractures of the articular surface of the tibia bones, the most common fractures are the external condyle, then the fractures of both condyles, and the least common are fractures of the internal condyle.
There are complete and incomplete condylar fractures. In complete fractures, the entire condyle or part of it is separated.
Incomplete fractures include cracks, limited depressions, crushing of the cartilaginous cover of the articular surfaces and the surface layer of the bone tissue of the epiphyses.
In practice, it is most advisable to divide all fractures of the tibial condyles into 2 groups:
1) fractures without violation of the congruence of the articular surface of the tibia and 2) fractures with violation of the congruence of the articular surface of the tibia.
Fractures of the condyles can be accompanied by fractures of the fibula, damage to the ligamentous apparatus of the knee joint, fractures of the intercondylar eminence, as well as damage to the menisci, which sometimes penetrate into the depths of the destroyed condyle.

Symptoms of tibial condyle fractures

With fractures of the tibial condyles, there are a sufficient number of signs to make a correct diagnosis: pain, hemarthrosis, typical deformity of the genu valgum or genu varum, lateral movements in the knee joint, dysfunction of the joint. The intensity of pain does not always correspond to the degree of damage. Local pain is of great diagnostic importance. It is determined by pressing with one finger. Hemarthrosis can reach large sizes and lead to a sharp expansion of the knee joint and poor circulation.
In such cases, it is necessary to urgently perform a puncture to remove the blood. Early active movements in the joint contribute to faster blood resorption.
A characteristic sign of condylar fractures is a typical deformity of the genu varum or genu valgum, which is explained by the displacement of fragments, as well as lateral mobility in the joint area. Active movements are sharply limited and painful. Radiographs make it possible to clarify the nature of the fracture and the degree of displacement of the fragments.

Treatment of tibial condyle fractures

The basis of treatment includes the following principles:
1) early, and if possible, anatomical reduction of fragments to restore the congruence of the articular surfaces;
2) reliable fixation of fragments before the onset of fracture consolidation;
3) the appointment of early active movements in the damaged joint;
4) late loading of the limb.
Treatment of fractures of the tibial condyles should be differentiated.
If there is a marginal fracture without displacement, a crack or an incomplete fracture, the limb is immobilized with a posterior plaster splint from the fingers to the upper third of the thigh for 3-4 weeks. Bed rest is indicated for 3-4 days. The patient can then walk with crutches. During the day, the splint is removed for the duration of active movements in the knee joint. Gradually increase the number of such exercises throughout the day.
In stationary conditions, the technique of adhesive or skeletal traction and the technique of simultaneous manual reduction with subsequent fixation using constant traction are used.
For displaced fractures of one condyle, adhesive traction on the shin is used with the limb extended. Two lateral reduction loops are used at the same time. The load along the length of the lower leg is 2-5 kg, on the adjusting loops 1.5-2 kg.
When the lateral condyle is fractured, a lateral loop is applied to the area of ​​the femoral condyles so that the traction is directed from the inside to the outside, and the loop located above the ankles is directed from the outside to the inside. This eliminates the typical deformation of a fracture of the lateral condyle, as well as reduces the displaced condyle and keeps it in the reduced position.
In case of fractures of the internal condyle, the location of the lateral reduction loops is the opposite of that described.
For fractures of one condyle with a large displacement, for fractures of one condyle with dislocation or subluxation of the other, as well as for fractures of both condyles with a significant displacement, skeletal traction is used using an ankle clamp. To bring together the condyles that diverge to the sides, a special apparatus designed by N.P. Novachenko or lateral loops are used.
In these cases, it is sometimes necessary to resort to immediate manual reduction of displaced fragments. Local, spinal or general anesthesia.
During traction, active movements in the joint begin on the 3-4th day after the elimination of acute pain. Early movements in the knee joint during traction contribute to the further reduction of fragments and the creation of congruence of the articular surfaces.
Adhesive traction is removed after an average of 4 weeks, skeletal traction is also removed after 4 weeks, then adhesive traction is applied for another 2 weeks.
After the traction is removed, patients rise to their feet with the help of crutches, without putting any weight on the injured leg. Considering the delayed consolidation of intra-articular fractures and the possibility of secondary subsidence of the condyle, full load on the limb is allowed no earlier than after 4-6 months.
Surgical intervention for fresh condylar fractures is used:
1) when a fragment is pinched in the joint cavity with impaired movement in the joint;
2) with significant displacement of fragments and failure of conservative methods of reduction;
3) with pronounced compression of the condyles;
4) for displaced fractures of the intermuscular eminence and failure of conservative reduction;
5) when the neurovascular bundle is compressed by a displaced fragment.
If there is a free fragment in the joint cavity, an arthrotomy is performed and the fragment is removed when the fragment is significantly displaced, and also when the neurovascular bundle is compressed by the displaced fragment, open reduction is performed, followed by fixation of the reduced fragment. It can be fixed with a bone autopin, a bone heteropin, a nail or a stainless steel screw. If the reduced fragment is firmly held in place, you can do without additional fixation.
Fragments set manually can be fixed with steel knitting needles, which are carried out using an electric drill.
In cases of pronounced compression of the condyles with fresh fractures, old, non-revulsed fractures, as well as secondary subsidence of the condyle due to early loading of the limb, osteoplastic surgery using the Sitenko method is used. The technique of the operation is as follows. An arcuate incision exposes the condyle. Using a wide chisel placed parallel to the articular surface, the condyle is dissected and carefully raised with a chisel and elevator so that its articular surface is in the same plane with the articular surface of the other condyle. A bone wedge made of hetarobone is inserted into the resulting gap. The angle at which the condyle needs to be raised, and accordingly the size of the wedge, is calculated before surgery using an x-ray.

A fracture of the condyle of the knee joint is enough to require treatment. The knee joint is one of the most complex and largest joints in the human body, and it is also the most vulnerable to injury. The most common type of injury in the knee joint is a fracture of the tibial or femoral condyles. Damage to the bone tissue of the joint is a serious injury, the treatment and correction of which requires effort, serious treatment and long-term rehabilitation.

Mechanisms and types of fractures

Understanding the mechanisms of injury is necessary for the diagnosis and treatment of injury. Fractures of the condyles of the knee joint occur in the following situations:

  1. Direct blows applied to the outer surface of the joint in a bent or extended state, such injuries often occur in car accidents.
  2. A fall with landing on a limb bent at the knee, the lateral and straight surfaces of the joint.
  3. Falling with straight legs.
  4. Forced deflections or rotations of the lower leg also lead to such injuries.

Such injuries are common in life and, as a rule, lead to combined injuries, with damage to several bone structures at once, ligament ruptures, chondromalacia or osteochondritis dissecans.

For reference! The complexity of the structure of the joint and the variety of mechanisms of injury determine the variety of fractures, so you can find many classifications and types of fractures of the femoral or tibial condyle, but the following injuries are clinically important.

Fracture of the condyle of the knee joint without displacement

Characterized by a crack or defect in the bone tissue. This type of fracture is treated by immobilization with a plaster cast for several weeks, full recovery occurs in 3-4 months.

Compression fractures of the tibial condyles

Occur by crushing against the condyle of the femur. This type of fracture is characterized by relative preservation of the integrity of the synovial membrane, which does not provide grounds for the development of arthritis. Also, with this fracture, less severe damage to the ligamentous apparatus is observed. The prognosis in this case is good, and if you seek help in a timely manner, surgical intervention can be avoided.

Restoration of the level of the displaced and depressed condyle is achieved through manual reposition and subsequent fixation on the table with traction or a normally applied plaster cast. Thus, wedging and fixation of the fragment in the knee joint occurs.

As an example, a fracture of the lateral condyle of the tibia. There is a characteristic separation of a large fragment of the condyle, with its deviation, displacement to the outside by several mm, and fragmentation of the articular surface of the bone is also observed. This type of fracture is caused by a slightly different position of the femur at the time of injury.

As a result of a strong impact of the femur on the articular surface of the tibia, it becomes wedged and splits the condyle. Typically, with this type of fracture of the lateral condyle of the tibia, the application of force occurs in a small area; as a result, the head of the fibula is not injured, but is separated along with the broken fragment of the tibial condyle by several mm.

The severity in this case may vary, depending on the degree of damage to the ligaments and blood vessels. But usually there are complete ruptures of the ligaments, severe damage to the menisci, which can be pressed into the tibial surface.

The cartilaginous base of the joint is damaged, which leads to arthritis and chondromalacia.
Damage to the vessels supplying the joint leads to insufficient blood supply to the articular structures, which is why tissue necrosis subsequently occurs; this can result, for example, in osteochondritis dissecans. Predictions in this case are made carefully.

Treatment and restoration in this case also involves returning the broken fragment to its anatomical position. This is also achieved in different ways and depends on the severity of the fracture, which is judged. In some cases, they are limited to manual reposition, but, as a rule, this is not enough. Then surgical reposition is indicated, and, if necessary, arthroplasty of the damaged structures.

Fractures of the lateral and medial femoral condyles

Possible with forced abduction and adduction of the lower leg that goes beyond the anatomical framework, as well as with a fall on outstretched legs. Fractures of the lateral and medial condyle of the knee joint also mean breaking off a fragment or the entire condyle with a displacement of 3 mm or more, or without it. Osteochondritis dissecans is also a complication.

Chondromalacia is a pathology of cartilage tissue in which depletion, thinning and destruction occur. With osteochondritis dissecans, detachment of a section of cartilage tissue from the bone is observed.

Important! Whatever the type of fracture, its treatment should take place in a hospital, by doctors, since its success and the elimination of complications depend on the time of treatment, the doctor’s literacy and proper treatment.

Symptoms appear almost immediately after a fracture, and they will help determine the type and complexity of the damage:

  • the appearance of a characteristic pain syndrome localized in the joint and hip;
  • instability, excessive mobility of the patella;
  • feeling of instability, vibrations in the knee;
  • upon palpation, pressing on the broken condyle of the knee joint, severe sharp pain appears;
  • limitation and severe pain in movements in the joint;
  • a characteristic crunch, also known as crepitation, upon palpation, is caused by the presence of movable bone fragments;
  • there will be swelling and swelling of the knee area, effusion in the joint cavity, which smoothes the outline of the joint.

Often, despite the presence of a fracture, patients successfully move on their own, and do not immediately consult a doctor, because it happens that there is no knee pain after an injury and a fracture.

Important! If there is a suspicion of a fracture, the presence of characteristic symptoms, or a previous injury, you should immediately consult a doctor, because sometimes there may be no pain. Failure to see a doctor in a timely manner may lead to the need for surgical intervention, which can be avoided if the fracture is fresh.

The doctor, after an external examination and based on the results of an X-ray examination in the required projections, determines the severity of the fracture and subsequent treatment.

Treatment

The treatment process is fundamentally different for patients with displaced and non-displaced fractures.

The first step in case of a fracture without displacement of the fragments is a puncture, through which the effusion and blood located in the joint cavity are removed. After this, a small amount of novocaine solution is injected into the joint cavity, then the joint needs to be immobilized with a plaster cast. Having previously bent the knee joint by 5-10 degrees, the limb is immobilized with a plaster cast.

The application period is about 2-3 months, after which physical therapy classes are necessary as rehabilitation. It is important for the rehabilitation period to start training the thigh muscles. This is done literally 2-3 days after applying the bandage by raising the limb. Later, after about 7 to 10 days, movement on crutches is allowed; it is very important that there is no load on the joint.

Therapeutic measures for fractures with displacement of bone fragments may be different, but initially reposition is required, the return of displaced structures to their normal state:

  1. Having determined the severity and type of fracture, the specialist performs manual reduction under anesthesia, fixes the upper part of the limb, manipulating the lower part. After which an immobilizing plaster cast is applied for the required period.
  2. The doctor may also decide to treat with constant traction if the fragment is displaced by more than 3 mm. This involves slowly reducing the fragments by applying a special splint to the limb and using a weight system. After a few weeks, if the reduction is successful, the traction system is changed to a plaster cast.

If conservative methods do not give the desired effect or the fracture is quite complex, surgery is prescribed. Displaced fragments are fixed with bolts during the operation, and fusion also occurs for a long time, after which the screwed in bolts are removed.

When the lateral part of the apex of the bone, called the tibia, is damaged, a fracture of the tibial condyle is inevitable. This type of injury is considered an intra-articular fracture, which occurs after a direct blow or a sharp fall on the knee joint or on a straight leg.

Often such damage is accompanied by indentation of small bone fragments or displacement. The main manifestation of a fracture is limitation of movements, severe pain, and hemarthrosis. The support is impaired, the knee joint moves poorly.

A fracture of the tibial condyle occurs as a result of a traumatic action of great force. As a rule, compression is performed with rotation along the axis. More than half of fractures of this type occur as a result of road accidents. Only a fifth of cases occur from falls from height. The type of injury is directly proportional to the fixation of the leg at the time of injury. Damage to the lateral condyle is possible when the leg is abducted to the side at the time of injury.

When the knee is extended, an anterior fracture occurs. In addition, a fracture of the tibial condyles can occur for a number of reasons, including diseases of the musculoskeletal system.

Classification

  1. External or external (lateral);
  2. Internal (medial).

As a rule, the thickening of the bone is a fragile part, since it is covered only by cartilage tissue, which has good elasticity, but at the same time it has poor resistance to damage. The most common predisposing factors that accurately predict a fracture of the intercondylar eminence of the tibia are straight legs when falling from a great height.

In such a deplorable case, strong compression of the condyles and subsequent division of the epiphysis into several parts is inevitable. The internal and external thickening of the bone is broken. There are several main types of fracture, strictly depending on the part of the joint:

  • An outwardly displaced shin implies a fracture of the lateral condyle of the tibia or various kinds of problems with it;
  • An internally displaced tibia leads to a fracture of the medial condyle.

A broad classification is inherent in injuries of this type. Incomplete and complete damage should be distinguished. With the latter, partial or complete separation of part of the condyle is observed. With incomplete damage, in the vast majority of cases, cracks and indentation are noted, but without separation.

There are two main groups of injuries:

  • With offset;
  • No offset.

Typically, damage to the condyles is accompanied by a number of other injuries, as diagnostics show. Along with the condyle, the fibula is injured, the knee ligaments are torn or completely ruptured, the intercondylar eminence and meniscus are broken.

Symptoms

These fractures are easily identified. Specialists initially carefully study the characteristic symptoms of damage:


It happens that the pain accompanying a fracture of the medial condyle of the tibia is completely inconsistent with the complexity of the injury. In this case, it is important to carefully feel the area of ​​damage (palpate the leg). It is important for the specialist what sensations the victim will experience during the process of applying force to specific points.

It is easy to find out the nature of the fracture yourself by pressing just a little on or near the knee joint. Unpleasant sensations will indicate the need for an urgent visit to a medical facility.

The injury is characterized by such a sign as hemarthrosis, which has reached a large size. The joint can increase noticeably in volume, because proper blood circulation is disrupted.

Having noted this, the specialist necessarily directs the patient to undergo a puncture. Puncture is the best procedure for removing blood accumulated in the joint tissues.

First aid

If you have sustained a fracture of the lateral tibial condyle or any other fracture, the injury should be diagnosed immediately and appropriate treatment initiated. First aid will help the patient wait for qualified specialists to arrive if he is unable to get to the hospital himself. First aid includes:

  1. Call an ambulance and clarify with a specialist the list of necessary medications allowed for the victim to take in order to relieve pain;
  2. Anesthesia of the damaged area using analgesic drugs;
  3. Treating the edges of the wound with an antiseptic; if the wound is open and there is noticeable bone displacement, a mandatory step is to cover the wound with sterile bandages, but tight bandages should not be used;
  4. Plugging with a sterile cloth will help stop the bleeding in the first couple of days.

If there is no displacement, you need to fix the leg by immobilizing the limb and applying a special splint made from nearby materials.

Diagnostics

X-ray of the joint is considered the only method of instrumental diagnosis when a fracture of the internal condyle of the tibia or another has occurred. The photograph must be in two projections - this is a prerequisite. Thanks to this, it is possible to establish with exact certainty the fact of damage and the nature of the displacement of the fragments.

If the X-ray results are too ambiguous, a CT scan of the joint may be additionally prescribed. When a doctor suspects meniscus or ligament damage, he may order an MRI of the knee.

Neurosurgeons may be involved when there is reason to suspect damage to the nerve bundle or blood vessels.

Treatment

If you have received a fracture of the tibial condyle, the treatment period for which is approximately 4 weeks, rest assured that full functionality of the limb will return no earlier than four months later. Treatment is often carried out conservatively, but it can be difficult to do without surgical intervention.

A closed fracture without displacement means that it is important to fix the limb very quickly to ensure that late displacement of the fragments is avoided. A plaster splint to the fingertips is the best option.

Three months after the injury, it is allowed to perform minimal loads so that the condyle of the bone does not settle. The leg is developed at 4 months, physiotherapy and massages are prescribed. When breaking the external or internal condyle causing displacement, be prepared for reduction before fixation. After the plaster splint is removed, the leg is examined again using x-rays.

Successful fusion of the bones means that a further plaster cast will be applied for 4 weeks.

Surgical treatment

When there is an impression fracture of the area in question, a comminuted fracture or displacement, surgery cannot be avoided. Using open reduction, the doctor compares the fragments. Screws, bolts and pins secure the debris before applying plaster. Recovery takes much longer in this case.

Rehabilitation period

Rehabilitation takes a very long time. It can take almost six months to recover and return to a full-fledged way of life. The recovery process begins exactly when the plaster cast is removed.

The rehabilitation specialist determines the necessary set of recovery measures.

Complications

Usually, satisfactory prognosis can be achieved if all medical recommendations are correctly followed. Premature loads provoke subsidence of one of the fragments, which can result in the development of limb deformity and progression of arthrosis. Possible complications:

  1. Arthrosis;
  2. Loss of motor function of the knee;
  3. Nerve damage;
  4. Infectious infection with an open fracture;
  5. Angular deformity of the joint;
  6. Joint instability.

Timely initiation of treatment in full compliance with medical instructions will help to avoid any disappointing consequences and restore the activity of the limb in all cases.

Modern medicine can help choose the most appropriate method of highly effective treatment for condylar fractures.


Fractures of the tibial condyles are a common sports injury if the direction of the traumatic force passes through the axis of the bone, that is, from top to bottom, for example, when landing unsuccessfully on straight legs during a long jump or falling from a sports motorcycle. But this could be the consequences of an accident, a fall from a height or on ice. There are options for a fracture of the internal or external condyle, or both at once, as well as intra- and extra-articular fractures, depending on the location of the fault line.

The structure of a healthy knee joint

The joint is formed by three bones: the femur, tibia and patella. Above the femur, two condyles form the articular surface: the outer or lateral and the inner or medial. The articular surface of the tibia is located below, and the patella is located on the side. The inside of the joints is covered with smooth cartilage tissue, for better gliding and greater range of motion. Features of the histological structure of the condyles of the femur and tibia suggest the occurrence of depressed and impacted fractures, since its structure is plastic and easily bent.
Often, fractures of the tibial condyles occur with displacement of fragments and disruption of the biomechanics of the joint. This entails a violation of the distribution of forces acting on the joint during walking and other physical activities. And after healing, if it does not happen correctly, inflammation of the joint capsule may occur, since the deviated parts of the bone will constantly “scratch” the inner surface of the joint or, under the weight of the body, the articular surfaces will become incongruent with each other.

Fracture of the lateral condyle of the tibia

It occurs most often as a result of violent actions, or excessive abduction of the leg to the side below the knee joint (occurs in sports injuries or traffic accidents). X-ray shows a displacement of the lateral condyle by more than four millimeters, the fault line runs obliquely or vertically. If the traumatic agent continues to impact the leg, then the fragments are displaced, otherwise (provided the limb is immobilized during transportation), the fracture passes without displacement.

Fracture of the external condyle of the tibia

This type of fracture occurs if the tibia is adducted toward the femur or the knee is bent more than forty-five degrees at the time of injury. It is equally common in everyday life, sports and road accidents. The fracture can also be localized using photographs in frontal and lateral projections, and a vertical photograph of the articular area. If nothing strange is detected during standard images, and the symptoms persist, it makes sense to take an x-ray in an oblique projection.

Symptoms of a fracture

The patient will most often complain of pain in the knee at rest and with the slightest movement; an inflammatory reaction with the accumulation of exudate, a violation of the integrity of the skin over the site of impact, and a decrease in the range of active and passive movements in the joint are objectively visible. The characteristic external deformation and defiguration of the joint is pronounced. The patient is forced to take the position that is least painful for him - the knee is slightly bent to reduce the tension of the ligaments, the muscles are relaxed. Most often, condyle fractures are not isolated; they are combined with a rupture of the anterior or posterior cruciate ligaments, collateral ligaments, discs, and menisci. Damage to blood vessels and nerves supplying the joint. The latter manifests itself in a decrease in the temperature of the lower leg and foot, and impaired sensitivity.

Treatment

There are four most common ways to treat a knee fracture and their combinations:
1. Pressure bandage (to keep fragments from moving).
2. Plaster cast and closed comparison of fragments.
3. Skeletal traction.
4. Open reduction, connection of fragments with fixing material (pins, plates).
How the injury will heal depends on the nature of the fracture, its type, the presence of additional pathologies and complications, as well as on the method used by the traumatologist.

The first two methods are conservative treatment, which involves therapy with cold, immobilization and a gradual increase in the load on the leg in general and the joint in particular. During the entire treatment, photographs of the healing leg are taken to monitor the process and prevent displacement of fragments or shortening of the limb. Plus, the patient is prescribed exercise therapy to prevent the appearance of contractures and a decrease in range of motion in the joints. This therapy is more suitable for older people who will not run, swim or otherwise put much strain on their leg in the future.
The last two methods are surgical, when, one way or another, invasive methods of treatment are involved. It is important that the operation is performed by an experienced specialist, since it depends on him how accurately the fragments will fall into place and grow together again. You can secure them with screws, or add a metal plate to them. Often during surgery it is necessary to examine the inner surface of the joint, then arthroscopy or arthrotomy is used, depending on the clinical situation and the complexity of the fracture. The entire operation process is controlled radiographically; pictures are taken directly on the operating table, which are filed in the medical history for further comparison and tracking of the dynamics of bone restoration.

Fractures of the tibial condyles occur more often from indirect trauma - a fall from a height onto straightened legs or a fall with a lateral deviation of the leg. In the first case, as a result of sharp compression, the denser part of the metaphysis of the tibia wedges into the spongy substance of the epiphysis and dismembers it into two parts - a fracture of both condyles occurs. If the tibia is excessively abducted outward, a fracture of the lateral condyle may occur (Fig. 67), and if the tibia is excessively abducted, a fracture of the medial condyle may occur.

Rice. 67. Types of fractures of the lateral condyle of the tibia.

Since condyle fractures are the result of massive trauma, they can be combined with damage to the menisci and ligaments, both lateral and cruciate. There are fractures of the condyles without displacement and with displacement.

Symptoms and diagnosis. Localized pain at the fracture site, swelling, increasing hemarthrosis of the knee joint, deformity of the genu valgum type when the external condyle is damaged and genu varum when the internal condyle is damaged. An increase in the volume of the proximal part of the tibia due to displacement due to fractures of both condyles, lateral mobility in the area of ​​the knee joint, complete impairment of the function of the limb. Radiography is mandatory, as it gives an idea of ​​the nature and degree of displacement of the fragments.

Treatment. In case of fractures of one or both condyles without displacement, when the congruence of the articular surfaces is not broken, the task of treatment is to prevent the possible later displacement of the fragments; this is achieved by fixing the limb with a posterior plaster splint or plaster cast from the groin to the tips of the toes. First, a puncture of the knee joint is performed, followed by the injection of 20-25 ml of a 2% novocaine solution into the joint. Fixation period is up to 4 weeks. Then they prescribe movement development, massage of the thigh and lower leg muscles, and physical therapy. To avoid subsidence of the condyle, loads are allowed no earlier than 2-3 months; work capacity is restored after 3-4 months. If treatment is carried out in a hospital setting, then instead of a plaster cast, an adhesive traction can be applied, which allows you to begin developing movements in the knee joint earlier.

In case of fractures of one of the condyles with displacement of the fragments, it is necessary to perform a reduction. Reduction can be done simultaneously manually or gradually using traction. During manual reduction, after anesthetizing the fracture site with 15-20 ml of 1% novocaine solution, the assistant, clasping the distal end of the thigh with both hands, firmly holds it, while the surgeon, with careful force, gradually retracts the tibia either outwardly - in case of a fracture of the internal condyle, or inwardly - in case of external fracture. During abduction or adduction of the tibia, tension occurs, respectively, on the internal or external lateral ligaments of the knee joint, which pull the condyle that has shifted upward to the level of the joint space. This is successful if the integrity of the collateral ligament is not broken. After a control x-ray, if the condition of the fragments is satisfactory, the limb is fixed in a plaster cast for 4-6 weeks, followed by development of movements in the knee joint, massage and physiotherapy. Full weight bearing on the injured limb is allowed 3.5-4 months after the fracture. Working capacity is restored after 4.5-5 months.

Reduction using the constant traction method is performed by applying adhesive rods to the thigh and lower leg to uniformly relax the muscles and using two reduction loops. If the condyle is significantly displaced, skeletal traction is applied. The reduction mechanism is the same as with manual reposition. When the lateral condyle is fractured, one loop is applied in the area of ​​the femoral condyles with traction directed outward, and the other on the lower leg - above the ankles with traction directed inward. In case of a fracture of the internal condyle of the tibia, the direction of traction is the opposite of that described. Continuous traction treatment has a number of advantages. It is rarely possible to accurately compare fragments simultaneously using a manual method. Meanwhile, even small irregularities and protrusions on the supporting surface of the tibia lead to the development of deforming arthrosis, pain and limitation of joint function. In restoring limb function after an intra-articular fracture, the main role is given to early movements. During these movements, the not yet fused but partially reduced condyle of the tibia, under the influence of pressure on it from the femoral condyle, is gradually established in the correct position, ensuring congruence of the articular surfaces.

When both condyles are fractured with displacement, treatment in most cases is carried out using skeletal traction. A staple or wire is passed over the ankles or through the heel bone. After eliminating the length offset manually or using side loops, eliminate the width offset. Movements in the knee joint begin early - on the 10-12th day after the fracture. Early movements facilitate the correct installation of displaced fragments. Skeletal traction is replaced with adhesive traction after 4 weeks. Considering the possibility of subsidence of the condyles, full weight bearing on the limbs is allowed no earlier than 4 months. Working capacity is restored 5-6 months after the injury.

The results of conservative treatment of tibial condyle fractures, especially with significant displacement, are not always good. Therefore, recently they are increasingly resorting to open comparison of fragments with their fixation with preserved homo- and heterobone, as well as screws, bolts and special stainless steel plates.

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