What is the treatment for a fracture of the lateral femoral condyle?

Treatment of Lateral Femoral Condyle Fracture

For displaced osteochondral fractures of the lateral femoral condyle, perform arthroscopic or open reduction with internal fixation using screws, suture anchors, or biological glue within 10 days of injury to achieve bone consolidation and restore articular congruity; fragments smaller than 5mm or involving non-weight-bearing surfaces can be arthroscopically excised. 1, 2

Initial Diagnostic Approach

• Obtain comprehensive radiographic evaluation including anteroposterior, lateral, oblique, and skyline patellar views, as the fracture may only be visible on lateral view in over 50% of cases 2
• Look for hemarthrosis with fat globules on clinical examination, which strongly suggests intraarticular fracture 2
• Perform MRI or arthroscopy to determine the true size and location of the fracture fragment, as plain radiographs frequently underestimate fragment size 3, 4
• Assess for associated patellar dislocation, as 31.6% of traumatic patellar dislocations in children result in lateral femoral condyle osteochondral fractures 2

Treatment Algorithm Based on Fragment Characteristics

Small or Non-Weight-Bearing Fragments

• Arthroscopic removal is appropriate for fragments less than 5mm, involving non-weight-bearing portions, or diagnosed more than 10 days post-injury 2
• This approach minimizes surgical morbidity while addressing loose bodies 2

Large or Weight-Bearing Fragments (Preferred Treatment)

• Perform surgery within 10 days of injury, as the host area begins filling in after this period and fragments will not fit back properly 2
• Arthroscopic reduction and internal fixation offers decreased blood loss, shortened operative time, excellent visualization, and faster recovery compared to open approaches 5
• Fixation options include:
  • TWINFIX Ti suture anchors in "X"-shaped configuration for secure fixation 1
  • Biodegradable screws for large fragments involving entire articular surfaces 3
  • Biological glue for appropriate fragment sizes (successful consolidation in 9 of 10 cases) 2
  • Traditional metal screws for definitive fixation 4, 5

When Arthrotomy is Required

• Convert to open reduction when the fragment is too large for arthroscopic manipulation or involves the entire weight-bearing surface 3
• Open approach allows direct visualization and more robust fixation options 2

Postoperative Management

• Immobilize in cylinder cast with non-weight-bearing status for 6 weeks 2
• Allow full weight-bearing at 3 months after confirming radiographic healing 3
• Obtain MRI at 6 weeks to assess bone consolidation and cartilage healing 3
• Monitor for complications including knee pain (occurs in approximately 26% of cases), recurrent patellar dislocation (16% within 6 months), and nonunion 2

Critical Timing Considerations

The 10-day window is crucial: Early surgery (within 10 days) achieves bone consolidation in 82% of cases with an average healing time of 8 weeks, whereas delayed treatment results in poor fragment fit and higher failure rates 2. Fragments diagnosed within 24 hours have the best prognosis 2.

Common Pitfalls to Avoid

• Do not rely solely on anteroposterior radiographs, as lateral views are essential for diagnosis 2
• Do not delay surgery beyond 10 days for large or weight-bearing fragments, as host site changes prevent anatomic reduction 2
• Screen for patellofemoral dysplasia, present in 80% of these patients, which increases recurrent dislocation risk and may require additional stabilization procedures 2
• Do not attempt fixation of fragments diagnosed more than 10 days post-injury; instead, perform arthroscopic excision 2