Definition
Coronal plane fracture of distal femoral condyle
- intra-articular
- often only attachment is posterior capsule
Epidemiology
Rare
Mechanism
Usually a severe valgus trauma
Xray
1. Unicondylar
Lateral femoral condyle > medial femoral condyle
2. Bicondylar
CT
Aids surgical planning
MRI
Excludes associated LCL / MCL injury
Management
Issue
Usually unstable and intra-articular
- needs ORIF
- can be associated with LCL injuries
Must preserve the posterior soft tissue for vascularity
Options
Lateral Approach
May need combined approach
a. Lateral between ITB and LHB
- elevate ITB
- open joint capsule anterior to gastrocnemius, posterior to LCL
- preserve lateral meniscu inferiorly
b. Lateral parapatellar
- may be needed for reduction
- allows AP screws
Vumedi video
Medial approach
a. Medial approach to knee
- semimebranosus inferior
- gastrocnemius posterior
- MCL anterior
- open posteriomedial capsule
- preserve medial meniscus inferiorly
b. Medial parapatellar
- allows direct reduction
- allows AP screws
Unicondylar Fixation
1. AP screws
2. PA screws
3. Combined
4. Consider buttress plate
Lu et al. J Int Med Research 2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384458/pdf/10.1177_0300060518798224.pdf
Bicondylar fixation
Lee et al. Case Report Ortho 2014
- lateral parapatellar approach with tibial tuberosity osteotomy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124765/pdf/CRIOR2014-139897.pdf
Results
Trikha et al. J Orthop Surg 2017
- 32 cases
- all united
- no athrithris
- stiffness in 4
- recommend early and aggressive ROM
https://pubmed.ncbi.nlm.nih.gov/28673200/
Onay et al. Injury 2018
- 13 patients
- OA developed in 50%
- AVN developed in 2/12
https://pubmed.ncbi.nlm.nih.gov/29198374/