Surgical Treatment of Impression Fracture of the Lateral Condyle of Tibia (Case Report)

Abstract

INTRODUCTION: Treatment of intra-articular fractures of the proximal tibial metaepiphysis can often cause difficulties in accurate restoring of the congruence of the articular surfaces of the knee joint. Such fractures may be accompanied by subsidence of the articular surface and the formation of a subchondral defect. In the absence of displacement of bone fragments and preservation of congruence of the articular surfaces of the knee joint, such fractures can be treated conservatively. In the opposite case, there is a need for a complete restoration of the articular surface of the tibia. It should be noted that among all fractures of the tibial plateau, more than half are fractures of the lateral condyle, also accompanied by the presence of an impression. A clinical case of surgical treatment of a 62-year-old patient, BMI (body mass index) 39, with an intra-articular multi-comminuted impression fracture of the lateral condyle of the tibia with displacement of bone fragments is presented. The patient gave her written consent to the use of her clinical data for scientific purposes. Upon admission to hospital, a closed intra-articular fracture of the external condyle (Schatzker II) was diagnosed with fragmentation and articular surface impression of more than 5 mm, and the presence of a spongy bone defect with a volume of about 4 cm3 as a result of the impression. Surgical treatment was performed that consisted of open reposition and restoration of the congruence of the articular surface, with simultaneous plasty of the defect of the external condyle with an autograft taken from the iliac crest, followed by osteosynthesis of the external condyle with a plate and screws. On the follow up examination 9 months after the surgical treatment, the patient developed post-traumatic osteoarthrosis of the knee joint with severe pain. Some probable errors in the preparation of the patient for surgical treatment, preoperative planning, surgical treatment, recovery in the postoperative period, as well as functional and radiological results of treatment are presented for discussion. CONCLUSION: The development of post-traumatic osteoarthrosis in the treatment of tibial condylar fractures still remains an important problem in modern traumatology. Special attention in the treatment of such fractures should be given to preoperative planning, surgical technique and implant selection. It is important not to lose communication between the patient and the surgeon throughout the entire recovery period.