Subchondral fracture of the lateral femoral condyle?

From the Guidelines

Subchondral fracture of the lateral femoral condyle is a serious injury that requires prompt medical attention.

Initial Management

• Immobilization and pain control are crucial in the initial management of subchondral fractures, with oral analgesics such as acetaminophen 650-1000mg every 4-6 hours or ibuprofen 400-800mg every 6-8 hours often being used 1.

High-Risk Stress Fractures

• Certain stress fractures, including those in the femoral neck and head, are considered high-risk due to their tendency for nonunion or delayed union, and may require more aggressive management, such as percutaneous screw fixation 1.

Specific Considerations for Subchondral Fracture of the Lateral Femoral Condyle

• While the provided evidence does not specifically address subchondral fractures of the lateral femoral condyle, it highlights the importance of prompt recognition and management of high-risk stress fractures in the femur, including those that may progress to more serious fractures and complications if left untreated 1.

Surgical Intervention

• In cases where surgical intervention is indicated, open reduction and internal fixation with screws or plates may be necessary to stabilize the fracture and promote healing, with post-operative rehabilitation protocols often including protected weight-bearing and physical therapy for 6-12 weeks.

Patient Risk Factors

• Patients with osteoporosis or those on bisphosphonate therapy are at high risk for fracture completion and may require more aggressive management and preventive strategies to deter progression to complete fracture 1.

From the Research

Subchondral Fracture of the Lateral Femoral Condyle

• A subchondral fracture of the lateral femoral condyle is a rare intra-articular injury that can occur with or without patellar dislocation 2, 3.
• The treatment of this type of fracture can be challenging and requires accurate reduction and stable fixation to allow early mobilization and reduce complications such as knee stiffness, malunion, or secondary osteoarthritis 4.
• Various treatment options have been reported, including:
  • Arthroscopic TWINFIX Ti suture anchor internal fixation 2
  • Bioabsorbable pin fixation 3
  • Open reduction and fixation with cannulated leg screws 4
• The choice of treatment depends on the specific characteristics of the fracture and the patient's individual needs.
• There is limited information available on the treatment of subchondral fractures of the lateral femoral condyle, and more research is needed to determine the most effective treatment options.

Related Fractures

• Subchondral fractures of the femoral head have been treated with intertrochanteric curved varus osteotomy (CVO), which has shown promising results in young patients 5.
• Subcondylar fractures, which occur in a different location, have been treated with open reduction internal fixation (ORIF), closed reduction with maxillomandibular fixation (MMF), and endoscopic open approaches 6.
• These treatment options may not be directly applicable to subchondral fractures of the lateral femoral condyle, but they highlight the importance of individualized treatment approaches for different types of fractures.