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Nurul & Raden


Bones
made up of
four main
bones- femur,
tibia, fibula &
patella
The main
movements of
the knee joint
occur between
the femur,
patella & tibia.
Joints..
- 3 joints within a single
synovial cavity :

1) Patellofemoral joint
-Between patella & the patellar
surface of femur
-Planar joint (gliding)


2) Medial condylar joint
3) Lateral condylar joint

- aka tibiofemoral joint
- Between femur & tibia
- Hinge joint (uniaxial)
Anatomical components of knee
Components
Capsule Ligaments
Extracapsular Intracapsular
Capsule
Surrounds sides & posterior
aspect of knee joint
On each side of patella, the
capsule is strengthen by
tendons of vastus medialis
& vastus lateralis
Inside this capsule is
synovial membrane which
provides nourishment to all
surrounding structures
Extracapsular Ligaments
Ligamentum patella
Continuation of quadriceps
femoris muscle

Oblique popliteal ligament
Derived from
semimembranosus muscle

Medial collateral ligament
(MCL)

Lateral collateral ligament
(LCL)

Posterior view
Intracapsular Ligaments
Intracapsular
Cruciate
ligaments
Anterior
Posterior
Meniscus
Medial
Lateral
Cruciate ligaments..

Anterior cruciate ligament
(ACL)
Posterior cruciate ligament
(PCL)
Origin Lateral femoral condyle Medial femoral condyle
Insertion Anterior intercondylar of tibia Posterior intercondylar of tibia
Action Prevent posterior
displacement of femur
Knee flex: Prevent anterior
displacement of tibia
Prevent anterior displacement
of femur
(Main stabilizer for femur in
weight bearing esp during
walking down hill)
Knee flex: Prevent posterior
displacement of tibia
Prevent hyperextension of knee
Provide rotatory stability
Resist excessive valgus and varus angulation
Posterior view
PCL
Anterior view
ACL double bundles
- Anteromedial (AM) bundle
prevent anterior displacement of tibia when knee
flex
- Posterolateral (PL) bundle
tightens when knee extend


PCL double bundles
- Anterolateral (AL) bundle
prevent posterior displacement of tibia when knee
near 90 flexion
- Posteromedial (PM) bundle
when knee extend

Meniscus

Fibrocartilage disc interposed in between
femoral condyles and tibial plateaus.
Have a triangular cross
section
thickest at the periphery
tapering to a thin central edge


Functions
- Load transmission
- Shock absorption
- Joint stability & lubrication
- Control rolling & gliding
actions of knee joint
Zones
1. Red zone
Meniscus base; in immediate
contact with joint capsule

2. Red-white zone
Intermediate meniscus region

3. White zone
White fringes


-Vessels penetrate through red zone until central third of
the meniscus (red-white)

-The white fringe indicates no vessels- nourished via joint
fluid
LATERAL
MENISCUS
MEDIAL
MENISCUS

Circular C-shaped

More mobile
- More likely
to move dt
loose
peripheral
attachment
Less mobile
- Less likely to
move dt firm
attachment to
tibia and
capsule via
deep MCL

Less likely to
tear
More likely to
tear
Left knee
Blood Supply of the Knee
Femoral artery popliteal
artery help to form arterial
network surrounding the knee
joint.
6 main branches:-
1. Descending genicular artery
2. Superior medial genicular
artery
3. Inferior medial genicular
artery
4. Superior lateral genicular
artery
5. Inferior lateral genicular artery
6. Anterior recurrent tibial artery

The medial genicular arteries
penetrate the knee joint.

Nerves of the Knee
Femoral nerve
Saphenous nerve

Sciatic nerve
Tibial nerve
Common peroneal
nerve
Superficial peroneal
nerve
Deep peroneal nerve
Lateral view
Patella
Flat, triangular bone
In front of the knee joint
Sesamoid bone within tendon
of quadriceps femoris
Dense cancellous tissue, covered
by a thin compact lamina
Function :
Protect the front of the joint
Increase leverage of Quadriceps
femoris by making it act at a
greater angle
Base
Apex
Articular surface
Anterior surface
Convex
Numerous rough and longitudinal striae
Covered by : an expansion from the
tendon of quadriceps femoris which it
continous below with the superficial fibers
of ligamentum patellae
Separated from integument by a bursa
Posterior surface
Smooth, oval, articular area
divided into two facets by a vertical ridge
: lateral and medial. the lateral facet is the
broader and deeper.
Below the articular surface is a rough,
convex, non-articular area
lower half : attachment to the ligamentum
patellae
upper half : separated from the head of the
tibia by adipose tissue.
Borders
Superior border (base) :
thick, and sloped from behind, downward, and forward
attachment of the portion of the Quadriceps femoris
which is derived from the Rectus femoris and Vastus
intermedius.
The medial and lateral borders
are thinner and converge
attachment of those portions of the Quadriceps femoris
which are derived from the Vasti lateralis and medialis.
Apex
Pointed
attachment of the ligamentum patellae
KNEE INJURIES
KNEE INJURIES
PATELLA

KNEE TIBIA
Dislocation of
patella
Dislocation of knee Tibial plateau
fractures
Fractured
patella
Acute knee ligaments
injuries (ACL, PCL,
MCL, LCL)
Patella tendon
injury
Meniscal injury

PATELLA FRACTURE
Patellar fracture
I : Undisplaced
crack fracture
II : Displaced
transverse fracture
III : Comminuted
(stellate) fracture
Mechanism of Injury
DIRECT FORCE (Fall onto knee / blow)
Against dashboard of car : undisplaced crack or else a
comminuted (stellate) fracture without severe damage to
the extensor expansions.


INDIRECT FORCE (Traction force that pulls the bone
apart and tears the extensor expansions)
Someone catches the foot against solid obstacle & to avoid
falling, contract the quadriceps muscle forcefully.
transverse fracture with a gap between the fragments.

Clinical Features
Knee becomes swollen
and painful. May be an
abrasion or bruising
over the front of the
joint.
The patella is tender
and sometimes a gap
can be felt.
Active knee extension
should be tested.
If there is an effusion,
aspiration may reveal
the presence of blood
and fat droplets.
If the patient can lift the straight leg,
the quadriceps mechanism is still
intact.
If this maneuver is too painful, active
extension can be tested with the patient
lying on his side.
X-ray
Fracture with little or no
displacement
Severe comminutions
Treatment
I . Undisplaced or minimally displaced fractures
Haemarthrosis should be aspirated.
The extensor mechanism is intact and
treatment is mainly protective.
A plaster cylinder holding the knee straight
for 34 weeks
Quadriceps exercises are to be practiced
every day.

II. Comminuted (stellate) fracture

Patella undersurface is irregular serious risk
of damage patellofemoral joint
Patellectomy
Preserve the patella if the fragments are not
severely displaced by applying backslab.


III. Displaced transverse fracture
The lateral expansions are torn and the entire extensor
mechanism is disrupted.
Operation is essential.
Patella repaired by the tension-band principle.
The fragments are reduced and transfixed with two stiff K-
wires; flexible wire is then looped tightly around the
protruding K-wires and over the front of the patella.
The tears in the extensor expansions are then repaired.
A plaster backslab or hinged brace (until active extension of
the knee is regained), removed every day to permit active
knee-flexion exercises.
Transfixed by K-wires
Malleable wire is then looped around
the protruding ends of the K-wires
and tightened over the front of the
patella.
PATELLA TENDON INJURY
Mainly occur in patient younger than 40
years old- athlete or non-athlete

Pain and tenderness in the middle of
patellar ligament may occur in athletes-
running and jumping sports

Previous history of local injection of
cortocosteroid

History of: forceful contraction on a flexed
knee (jump landing, weight lifting,
stumbling)

Complain of: sudden pain on forced
extension of the knee

Physical examination revealed
hemarthrosis, proximally displaced patella,
incomplete extensor function.
Mechanism :
Sudden resisted extension of the knee

Diagnosis by history, physical examination and
radiological investigation.
Lateral X-ray of the knee
Normal lateral x-ray of knee with
intact patella
Lateral x-ray of knee with rupture of patellar
tendon - high riding patella
MRI : help to distinguish a partial from a complete tear
Treatment
Partial tears
Apply plaster
cylinder
Complete tears
Operative repair/
reattachment to
the bone.
Limits amount of
flexion by using
hinged brace for
6 weeks

PATELLA DISLOCATION
Patella slips out of its normal position in the patellofemoral groove
Knee is normally angled in slight valgus natural tendency for the
patella to pull towards the lateral side when the quadriceps muscle
contracts.
Traumatic dislocation : severe contraction of the quadriceps muscle
while the knee is stretched in valgus and external rotation
Patella dislocates laterally and the medial retinacular fibres may be torn

Clinical features
First-time dislocation : tearing sensation, feeling the knee has
gone out of joint
When running, collapse and fall to the ground
Swelling in the knee joint
Pain around the patella Impaired mobility in the knee
Obvious displacement of the knee cap lateral side of the knee
The top of the patella attaches
to the quadriceps muscle via the
quadriceps tendon,

the middle
to the vastus medialis obliquus
(VMO) and vastus lateralis
muscles
The bottom to the head of the
tibia (tibial tuberosity) via the
patellar tendon
The medial patellofemoral
ligament attaches horizontally
in the inner knee to the
adductor magnus tendon and is
the structure most often
damaged during a patellar
dislocation.
Finally, the lateral collateral and
medial collateral ligaments
stabilize the patella on either
side.
Predisposing Factors
Young, female
Athletic Population
Patellar dislocation occurs in sports that involve rotating the knee.
Direct trauma to the knee can knock the patella out of joint.
Anatomical Factors
Insufficient VMO strength - The VMO functions in maintaining the patella in its desired
position within the patellofemoral groove during knee movements by pulling it towards
the middle of the knee joint - an action known as 'tracking'.
Q-angle - Larger than normal femoral angle (known as the Q-angle) and may have a
'knock-kneed' appearance (genu valgum). When the person straightens their leg, the
patella will be forced to the outside of the knee. Thus any extra force applied to the
inside of the knee may result in patellar dislocation.
due to the central line of pull found in the quadriceps muscles that run from the anterior
superior iliac spine to the center of the patella.
Male < 15
Female < 20
> 25 high risk for patellar dislocation
Treatment
Conservative
Pushed back patella into place. With knee straight, plaster backslab is
applied for 3 weeks.

Operative
When recurrent dislocations occur. To limit the amount of lost time in
competition and to reduce the chances for cartilage lesions on the
undersurface of the patella, which often are non-reparable, patellar
stabilization procedures are appropriate. These procedures can be either
soft tissue or bone procedures, or a combination thereof. First-time
traumatic patellar dislocations can also be treated with procedures such
as this, and in chosen situations doing so may be appropriate.
Surgically treating those dislocations by lessening lateral tension and
tightening medial restraint could reduce this recurrence rate
Recurrent Dislocation
15-20 % patient treated conservatively will
developed recurrent dislocation.
Predisposing factors :
Generalized joint laxity
Marked genu valgum
Unduly high patella
DISLOCATION OF KNEE

Femur-tibia joint disrupted
Cruciate ligaments & one/ both lateral ligaments
are torn

Causes: Trauma
distinguish between high velocity injuries & low
velocity injuries (as this reflects incidence of vascular
and nerve injuries);
low-velocity: occurrence of vascular injury is about 5%
and nerve injury is about 20%
Class
Anterior
31%
Posterior
25%
Lateral
13%
Medial
3%
Rotatory
4%
1. Positional classification
(Kennedy)
-based on position of displaced
proximal tibia
Anterior dislocation
> 30 of hyperextension to produce this injury
often PCL & ACL will both be torn
either MCL or LCL or both will be injured

Posterior dislocation
Anterior-to-posterior force on prox tibia (force
on flexed knee, dashboard injury)
possible extensor mechanism disruption
A P P A
A A P P
Lateral dislocation
Varus force

Medial dislocation
Valgus force

Rotatory dislocation
Rotatory force
Usually posterolateral
dislocation
+ dimple sign
Often irreducible!
Medial
L L M M
Lateral
L L M M
Dimple sign
2. Anatomical classification (Schenck; modified by
Wascher)
- Based on ligamentous injury involvement
KD I Multiligamentous rupture with either
cruciate intact
KD II Bicruciate rupture with both collaterals intact
(rare)
KD IIIM Bicruciate and MCL rupture
KD IIIL Bicruciate and LCL rupture
KD IV Panligament rupture
KD V Knee dislocation with periarticular fracture
C (+ to above) Arterial injury included
N (+ to above) Nerve injury included
1. Severe bruising
2. Gross deformity
3. Swelling
4. Pain
5. Immobility
6. Knee instability

Special test
-to assess ligamentous injury
*Pulse (DPA, PTA)
-exclude popliteal
artery involvement
*Distal sensation &
dorsiflexion
exclude nerve injury
Examine!
1. X-ray (AP & lateral view)
- Dislocation
- may show periarticular #
- # of tibial spine (dt ligament avulsion)

2. Ankle-brachial pressure index (ABPI)..
3. Duplex US
4. CT angiography
5. Arteriogram

6. MRI
assessment of which ligaments are intact
determine whether ligament tears are midsubstance or are
avulsions (off the femur or tibia)..

if doubt
about
circulation
From A&E to ward mx

1) Reduction under anaesthesia (URGENT!)
No pulse reduce immediately
Has good peripheral pulse pre-reduction x-ray

2) Rest limb on backslab with knee flex in 15
To avoid re-dislocation

*No POP apply d/t swelling

3) If joint is unstable apply external fixator
4) Apply ice & elevate knee (to reduce oedema)
5) Post-reduction x-ray before assess for ligament injury
6) Admit ward & check circulation during 48 hours
Operation if:

Open wound
Vascular damage
*Opportunity is taken to repair the ligaments and
capsule; otherwise left undisturbed

7) Swelling subsided apply cast for 12 weeks
8) Rehabilitation quadriceps muscle exercises

Popliteal artery injury
Peroneal nerve injury
Open knee injury
Compartment syndrome
Acute
Knee instability
Joint stiffness
Post-traumatic osteoarthritis
Chronic
ACUTE KNEE LIGAMENTS INJURY
Anterior Cruciate Ligament Injury
One of the most common knee injuries is an ACL
sprain or tear
Common in sports such as soccer, basketball and
rugby
About half of all injuries to the ACL occur along with
damage to other structures in the knee, such as
articular cartilage, meniscus or other ligaments


Non-contact
Traumatic force during twisting motion in weight-bearing knee
usually occurs when the athlete lands on the leg and quickly
pivots in the opposite direction (landing from jump)


ACL: Mechanism of Injury
Contact
Blow to the lateral side of the extended knee esp at 0-30

Usually a/w unhappy triad of injuries:
1) MCL tear
2) Meniscus tear
3) ACL tear


Segond fracture
- avulsion # of
lateral aspect
proximal tibial
plateau
PCL is approximately twice as strong and twice as
thick as the normal ACL
Therefore PCL is less commonly injured & an injury
to PCL requires a powerful force
Usually associated with ACL and collateral ligament
injury (knee dislocation)

Posterior Cruciate Ligament Injury
PCL: Mechanism of Injury
Direct blow (anterior
force) onto the lower
leg when knee flexed

e.g. a bent knee hitting a
dashboard in a car
accident or a football
player falling on a knee
that is bent


Symptoms
ACL injury PCL injury
Has popping sound No popping sound
Knee swelling (haemathrosis)
will occur between 2-12 hours of
injury
Knee swelling (haemathrosis)
within 3 hours of injury
May/ may not has immediate
pain at knee joint
Pain at knee joint (common)

Instability sensation knee
giving way
Instability sensation knee
giving way
Discomfort when trying to put
weight on injured leg
Difficulty walking

Signs
Examine ACL injured PCL injured
LOOK Gross effusion (diffuse
knee swelling)
Knee swelling (mild)
Skin changes (contussion)
Positive posterior tibial sag sign
FEEL Tenderness Tenderness
MOVE Limited ROM (lack of
complete extension)
Usually full range of motion

SPECIAL
TEST
+ve anterior drawer test
(AM bundle tear)
+ve Lachman test
(PL bundle tear)
+ve posterior drawer test

Grading of injuries
Grading of ACL tear (based on physical examination)
Grade 1- 1-5 mm difference
Grade 2- 6-10 mm difference
Grade 3- 11-15 mm difference

Posterior sag sign
Grade I -side-to-side asymmetry exists but tibial
plateau is anterior to femoral condyles
Grade II -tibial plateau is even with femoral condyles
Grade III- tibial plateau falls behind the femoral
condyles.

Investigation
i. Plain x-ray of the knee
to look for avulsion fracture

ii. Stress x-ray
show whether the hinges open on one side (instability)

iii. MRI (90-98% sensitivity for ACL tear)
differentiate partial & complete tears

iv. Arthroscopy
for reconstruction of cruciate ligament tears
Medial Collateral Ligament Injury
Function of MCL
resists widening of
inside of the knee
joint
prevents the knee
joint from medial
instability (prevents
valgus angulation
of knee)
MCL: Mechanism of Injury
results of direct blow to lateral side of knee
This pushes the knee inwards (toward the other knee)
excessive valgus force applied to a partially
flexed knee
E.g. when a rugby player gets clipped on the outside of
the leg, this opens the angle between the femur and
tibia, stretching the MCL & leads to tear or complete
rupture.

May be an isolated injury, or it may be part of a
complex injury to the knee.

Lateral Collateral Ligament Injury
Function of LCL
prevents the knee joint from lateral instability
(prevents varus angulation of knee)


LCL: Mechanism of Injury
results of direct blow to medial side of knee..
occurs in sports that require a lot of quick stops &
turns (e.g. soccer, basketball, skiing) or ones where
there are violent collisions (e.g. football or hockey)
greater force is required to rupture LCL than MCL
often accompanied by other injuries;
common peroneal nerve injury: it is near LCL- can be
stretched during the injury or is pressed by swelling in
the surrounding tissues
rupture of the biceps femoris (hamstring) tendon
Symptoms

MCL LCL
SYMPTOMS Pain ranging from mild
to severe (depending on
how serious the injury)
-Pain that can be mild or acute
-Numbness or weakness in the
foot if involve peroneal nerve
-Stiffness
-knee may give way under stress or may lock

SIGNS Swelling

Tenderness along inside
of knee

Positive valgus stress test
Swelling

Tenderness along outside of
knee

Positive varus stress test

Investigation
MCL LCL
Plain knee x-ray
-Calcified deposit seen on
medial site of knee
(Pellegrini-Steida syndrome)

Plain knee x-ray
- Fibular head avulsion #

Stress knee x-ray
-Complete tear of medial
ligament
Stress knee x-ray
-Complete tear of lateral
ligament

MRI MRI
RICE method
Used for acute soft tissue (sport) injury

Rest: vital to protect the injured muscle, tendon,
ligament or other tissue from further injury and to
promote effective healing.

Ice: Cold provides short-term pain relief & limits
swelling by reducing blood flow to the injured area.
(apply cold compresses for 15 min and then leave
them off for the skin to re-warm)

Compression: helps limit & reduce swelling.
Some people also experience pain relief from
it.

Elevation: help to control swelling. It's most
effective when the injured area is raised above
the level of the heart. (if injury to ankle, pt
lying on bed with foot propped on one or two
pillows)

Management of Acute Ligament Injury
Sprains and partial tears
i. RICE method
- Weight bearing is allowed with knee is protected from
rotation or angulation strains by a heavily padded bandage
or functional brace

ii. +/- aspirate haemarthrosis, NSAID

iii. Active exercise
- to prevent adhesion during spontaneous healing (intact
fibres splint the torn ones)
Physiotherapy
early ROM &
strengthening of
muscle that
stabilizes knee jt
Complete tears
Isolated tears of PCL/ MCL/ LCL treated as above
Isolated tears of ACL may be treated by early operative
reconstruction if patient is professional sportsman

Avulsion # of tibial intercondylar eminence
Reducible fragment & can fully extend knee
immobilize in plaster cylinder for 6 weeks
Irreducible or block to full extension open reduction
& fixation (strong sutures/ small screws if physis has
closed) + immobilize in plaster cylinder for 6 weeks

Combined injuries
(ACL + collateral ligs OR PCL + collateral ligs)

Joint bracing & physiotherapy to
restore good ROM
If involve ACL ACL reconstruction
If involve PCL PCL reconstruction
+ repair all damage structures

MENISCAL INJURY
Mechanism of Injury
Meniscus been split in its length by a force
grinding in between femur and tibia
In young adults, usually due to rotational
grinding force
Weight is taken on flexed knee & theres twisting strain
e.g. footballers flex and twist the knee + direct contact (tackle)
leading to tear
Middle-aged/ elderly often caused by stiffening
and menisci fibrosis that has restricted mobility
of the meniscus tear (even with little force)
Medial meniscus is commonly affected than
lateral meniscus.
Medial meniscus attached to the capsule.
This make it less mobile compared to lateral
meniscus, thus it cannot easily accommodate to
normal stresses.


TYPES
OF
TEAR
Longitudinal
or vertical
(bucket-
handle)
Flap or
oblique
Radial or
transverse
Horizontal
Complex
degenerati
on
most common
OA-changes associated
Confined to centre; usually degenerative or due to
repetitive minor trauma & some a/w meniscal cyst

Bucket-handle tear
Split is vertical and runs along part of the
circumference of the meniscus create loose
slivers which is still attached anteriorly and
posteriorly.

posterior
anterior
Longitudinal/ vertical
tear
Bucket-handle
tear
Handle displaced into
intercondylar fossa
(centre of the knee
joint) jammed
btwn femur-tibia
block to extension
(locked knee)
A longitudinal tear is a vertical tear in the meniscus
with a longitudinal direction, usually located in the
periphery of the meniscus.

The longer the tear, the more unstable it is; leading
to dislocation of the central part of the meniscus
buckethandle tear.

Flap/ radial/ horizontal tears
* A flap tear may also be caused by
a horizontal tear
A flap tear is an oblique
vertical cleavage
producing a flap (parrot
beak)
A radial tear is a vertical
tear starting from inner
free margin toward
periphery
Symptoms
Young person
twisting injury to knee on the
sports field
Pain severe & further activity
is avoided
Swelling (appears some hours
later/ the next day)
Knee is locked in partial flexion
With rest, initial symptoms
subside, only to recur periodically
after trivial twists or strains
Sometimes knee gives way
spontaneously & again followed
by pain & swelling
locking
-sudden inability to extend the knee
fully but able to fully flex the knee
suggest a bucket-handle tear
-Patient sometimes learn to unlock
the knee by bending fully or twisting
it from side to side
Patient > 40 yo
initial injury maybe
unremarkable
chief complaint mainly
recurrent giving way or
locking
Signs
Joint held in flexed position
Joint effusion
Quadriceps muscle wasting (late presentations)
Tenderness around joint line
Flexion is full but extension is often slightly
limited
Positive McMurrays or Apleys Grinding
Test..
Investigation
X ray (usually normal)
Arthroscopy
Advantage in identifying & treating lesion at the
same time
MRI
Most reliable to confirm dx
Absent bow-tie sign
May reveals tear that is
missed by arthroscopy


Management
Conservative management

If knee is not lock tear maybe at peripheral may heal
spontaneously

Joint held straight in backslab for 3 to 4 weeks
Physiotherapy
Analgesics
Activity modification

Operative management
Surgery indicated if:
a) the joint cannot be unlocked
b) symptoms are recurrent

Tear close to periphery sutured (have capacity to
heal)
Tear other than peripheral third excise the torn
portion

FRACTURE OF TIBIAL PLATEAU
Tibial plateau is the
top of the tibia that
makes up part of the
knee joint
There are two bulges
at the end of the tibia
called lateral and
medial condyles
Anatomy of tibial plateau
Causes of tibial plateau #
Strong bending force combined with axial loads
e.g. a car striking on a pedestrian (from knee side) aka
bumper fracture; fall from a height in which the knee is
forced into valgus or varus

One or both tibial condyles are crushed or split by
opposing femoral condyle

Most commonly affect lateral tibial plateau due to:
valgus alignment of lower extremity
most injuring forces are directed laterally to medially

Clinical features
Joint swollen & has doughy feel of
heamarthrosis
Diffuse tenderness on side of fracture site
Diffuse tenderness on opposite site (if
associated with ligament injury)
Restricted movement or unable to bear weight

Investigation
X-ray : multiple views to
show true extent of the #
Schatzker V tibial
plateau fracture
Schatzkers
classification
based on fracture
pattern and fragment
anatomy
Treatment
Principle: function is more important than pretty x-ray

Traction alone often produces a well-functioning knee

Undisplaced & minimally displaced lateral condyle #
Aspirate haemarthrosis
Apply compression bandage
Knee movements as soon as pain & swelling subsided
Hinge cast-brace
* weight-bearing is not allowed for another 3 weeks
Marked displaced &/or comminuted lateral condyle #
Open reduction and internal fixation (lag screw & buttress
plate)
Elevate depressed area
Bone grafting to support the reduction

Medial condyle #
ORIF
Repair associated lateral ligament damage

Bicondylar #
ORIF (combination of screw fixation and circular external
fixation offers satisfactory stabilization)

Osteoporotic condylar fractures
As above, sometimes need total knee replacement
Complication
Early Late
Compartment
syndrome
-esp type 5 & 6: tendency to
bleed and swelling

examine leg and foot
repeatedly for sx of
compartment syndrome
Joint stiffness
-failure to regain full knee bend
minimised by early movement

Deformity
-residual valgus or varus deformity
is quite common
-compatible with good function

Secondary osteoarthritis
-caused by plateau depression, knee
deformity or ligamentous instability

Thank you for your attention