1 Principles topenlarge
Anatomical reduction of the articular fracture component and fixation with absolute stability is mandatory.
Lateral versus medial condylar fractures
The operative procedures for lateral condylar fractures and medial condylar fractures are comparable. A lateral condylar fracture treatment is shown here.
Due to the axial forces acting on this lateral split wedge fragment, this injury usually requires a buttress plate as simple screws may not hold the reduction as securely; especially in older patients.
2 Patient preparation and approach topenlarge
This procedure is normally performed with the patient in a supine position.
For this procedure an anterolateral approach is used.
3 Reduction topenlarge
Indirect reduction may be attempted by external manipulation of the fractured fragment using clamps. The accuracy of reduction should be checked with an arthroscope if no arthrotomy is carried out. In cases where adequate closed reduction is not achieved the joint must be opened in order to carry out an anatomical reduction of the joint surface. This may also be necessary to repair the lateral meniscus which is often injured in association with these fractures.
Clinical image showing the clamp application.
4 Fixation topenlarge
Lag screw application
Once reduction of the joint fragment is obtained, two partially threaded cancellous bone screws are inserted to securely fix the fracture. In cases of good bone substance, stable fixation may be easy to obtain and no further implants are needed.
Click here for a detailed description of the lag screw technique.
The cortex in the lateral tibial head is thin. Therefore, the use of washers is advised.