Treatment of Femoral Condyle Fractures
Surgical treatment is recommended for femoral condyle fractures with displacement greater than 2-3 mm or disruption of the extensor mechanism to optimize functional outcomes and reduce complications. 1
Classification and Assessment
Femoral condyle fractures can be categorized as:
- Coronal plane (Hoffa) fractures
- Sagittal plane fractures
- Osteochondral fractures
Initial Evaluation
- Assess displacement (>2-3 mm indicates surgical intervention)
- Evaluate extensor mechanism integrity
- Determine fracture pattern through radiographs and CT imaging
Treatment Algorithm
1. Non-Displaced Fractures (<2 mm displacement)
- May be treated conservatively in select cases with:
- Limited weight-bearing with crutches or walker for 4-6 weeks
- Pain management with appropriate analgesics
- Progressive mobilization as symptoms allow
- Regular radiographic follow-up to monitor for displacement
2. Displaced Fractures (>2-3 mm)
- Surgical intervention is indicated 1
- Timing: Early surgical intervention (within 24-48 hours) is recommended to reduce risk of complications 2
- Surgical techniques:
3. Fixation Methods
- Tension band wiring: Most common technique for patellar fractures, offering dynamic compression 1
- Cannulated screw fixation: Lower reoperation rate (23%) compared to Kirschner wires (41%) 1
- Arthroscopic-assisted fixation: For select cases, particularly osteochondral fractures 4
Postoperative Management
Pain Management
- Implement multimodal analgesia including:
- Peripheral nerve blocks
- Regular paracetamol
- Cautious use of opioids (avoid as sole analgesic due to risk of respiratory depression and confusion) 1
Mobilization and Rehabilitation
- Early mobilization to prevent stiffness
- Thromboembolic prophylaxis throughout hospitalization 1
- Progressive weight-bearing as tolerated
- Return to full activities typically at 3-4 months based on radiographic healing and functional recovery 1
Follow-up Schedule
- Radiographic evaluation at:
- 6 weeks
- 3 months
- 6 months
- 1 year
Complications and Prevention
Common complications include:
- Pain associated with hardware
- Infection
- Pseudarthrosis
- Post-traumatic arthritis
- Arthrofibrosis
- Extensor mechanism insufficiency 1
For elderly patients:
- Evaluate and treat underlying osteoporosis
- Ensure adequate calcium and vitamin D intake
- Consider nutritional supplementation (60% of patients may be malnourished) 1
- Monitor cognitive function and renal function 1
Special Considerations for Hoffa Fractures
Hoffa fractures (coronal plane fractures of the femoral condyle) are unstable and prone to nonunion if treated non-operatively. These should be treated with open reduction and internal fixation to achieve anatomic reduction with stable fixation while preserving blood supply 3, 4.
By following this treatment algorithm, patients with femoral condyle fractures can achieve optimal functional outcomes with reduced risk of complications.