From the Research
The treatment plan for a posterior medial femoral condyle (PMFC) fracture typically involves surgical intervention with open reduction and internal fixation (ORIF) using buttress plates, lag screws, or headless compression screws to restore articular congruity and knee stability, as seen in a case report published in 2020 1. Initial management includes immobilization with a knee brace or splint, pain control with medications such as acetaminophen (1000mg every 6 hours) or NSAIDs like ibuprofen (600mg every 6 hours), and non-weight bearing status on the affected limb. Definitive treatment requires surgical fixation to prevent further displacement and articular damage, with surgery generally performed within 1-2 weeks of injury. Postoperatively, patients follow a rehabilitation protocol beginning with protected weight bearing for 6-8 weeks, followed by progressive weight bearing and range of motion exercises. Physical therapy typically starts 1-2 weeks after surgery, focusing initially on quadriceps strengthening and gentle range of motion, advancing to more intensive strengthening at 6-12 weeks. Full recovery may take 4-6 months. This approach is necessary because PMFC fractures involve a weight-bearing surface of the knee joint, and anatomic reduction is crucial to prevent post-traumatic arthritis, knee instability, and long-term functional limitations. Some studies suggest that arthroscopy-assisted fixation is an option for treatment, especially for minimally displaced fractures, as it allows for evaluation of other intra-articular structures and decreases blood loss and surgical time 2, 3. However, non-operative management is rarely recommended except in minimally displaced fractures or patients with significant surgical contraindications. Key considerations in the treatment plan include:
- Anatomic reduction and stable fixation to restore articular congruity and knee stability
- Early surgical intervention to prevent further displacement and articular damage
- Protected weight bearing and progressive range of motion exercises in the postoperative period
- Quadriceps strengthening and gentle range of motion exercises in physical therapy
- Full recovery may take 4-6 months, with regular follow-up to monitor progress and prevent complications.