CHAPTER XIV - FRACTURES OF THE FEMORAL AND TIBIAL CONDYLES

Summary

The injuries specially to be considered under this heading are: (i) T-shaped ir, the tibial plateau, and (4) depressed I supracondylar fractures of the femur, (2) fractures of the medial femoral condyle, (3) T-shaped fractures of th fractures of the lateral tibial condyle.

The principles which should dominate treatment must take into account the following three features:

1. They are fractures involving a joint.

2. They are fractures of cancellous bone and are either comminuted or impacted.

3. They occur commonly in elderly patients and only rarely in athletic age groups.

These features demand a method with the following requirements:

1. Early mobilisation because the joint is involved.

2. Avoidance of traction and the encouragement of ‘controlled collapse.’ Controlled collapse in fractures of cancellous bone favours rapid consolidation and therefore indirectly promotes the return of joint mobility.

3. Acceptance of radiological deformity if clinical deformity is not gross. This is often made possible by the patient's age and is part of the principle of ‘controlled collapse.’

When these principles are observed the rate of consolidation and recovery of joint mobility in elderly patients is sometimes quite astonishing. It is no uncommon thing to find a fracture quite painless at three weeks under this regime. In the patient, aged eighty-one, illustrated in Fig. 152, the T-shaped supracondylar fracture of the lower end of the femur was treated on a Thomas splint with fixed traction. While permitting collapse of the fracture from its original position after reduction the shortening became excessive (Fig. 153).