Fractures of Femoral Condyles

Fractures of the femoral condyles account for 4 percent of femur fractures and include supracondylar, intercondylar, condylar, and distal femoral epiphyseal fractures (Fig. 2.66:2.). Most often, these injuries are secondary to direct trauma from a fall with axial loading or a blow to the distal femur. Examination reveals pain, swelling, deformity, rotation, shortening, and an inability to ambulate. Although neurovascular injuries are uncommon, the potential for popliteal artery injury exists so the status of distal sensation and pulses must be checked. The space between the first and second toe, innervated by the deep peroneal nerve, should be tested for sensation. In addition, a search for ipsilateral hip dislocation or fractures, and damage to the quadriceps apparatus must be made. Incomplete or nondisplaced fractures in any age group and stable impacted fractures in the elderly can be treated with cast immobilization.7 Open reduction and internal fixation is generally required for displaced fractures or if there is any degree of joint incongruity present. 8 Therefore, leg splinting and orthopedic consultation is essential. The overall progress of these injuries is fair. Complications include deep venous thrombosis, fat embolus syndrome, delayed or malunion, and the subsequent development of osteoarthritis.

FIG. 266-2. The supracondylar and condylar areas of the femur, and the medial and subcondylar areas of the tibia. [Modified from Hohl M, Larson RL: Fractures and dislocations of the knee, in Rockwood CA Jr, Green DP (eds): Fractures, vol 2. Philadelphia, Lippincott, 1975, pp 1132, 1147. Used by permission.]

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