Fracture Medial Condyle

SH III and IV are uncommon and they may be unicondylar or bicondylar. With SH III, the fracture line often extends through the intercondylar region and the physeal separation is of the medial condyle. 

An estimation of the distribution of fracture patterns about the elbow is supracondylar (70%), lateral condyle (15%), medial epicondyle (10%), olecranon (5%), radial neck (1%), medial condyle (1%), capitel-lum (1%), T condylar (<1 %). 

The blood supply to the trochlea is via two terminal interosseous branches of the recurrent ulnar artery, the lateral trochlea and medial trochlea arteries. The medial artery maybe damaged in fractures of the medial condyle, leading to avascular necrosis. 

Some fractures may be reduced by closed manipulation and stabilisedby percutaneous K-wires. Evaluation of fracture reduction may be aided by intraoperative arthrogram. The most stable and therefore ideal configuration of K-wires is for a common entry point on the lateral edge of the condyle, with one wire running transversely to the medial condyle, and the second at about 60 aiming at the medial cortex above the olecranon fossa. 

Extension inj uries are reduced by placing the arm into full extension, correcting the varus or valgus, treating the associated injury such as radial head or medial condyle fracture, before immobilising in a cast for 3 weeks in slight flexion. 

Kilfoyle RM (1965) Fractures of the medial condyle and epi-condyle of the elbow in children. Clin Orthop 41 43-47 Lee SS, Mahar AT, Miesen D, Newton PO (2002) Displaced pediatric supracondylar humerus fractures biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop 22 440-443... 

Leet AI, Young C, Hoffer MM (2002) Medial condyle fractures of the humerus in children. J Pediatr Orthop 22 2-7 Lyons JP, Edwin A, Hoffer MM (1998) Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children s elbows. J Pediatr Orthop 18 43-45 Lyons ST, Quinn M, Stanitski CL (2000) Neurovascular injuries in type III humeral supracondylar fractures in children. Clin Orthop 376 62-67... 

Fig. 14.8. Types of tibial plateau fractures I, split fracture of the lateral tibial condyle II, split fracture with associated depression III, depressed fracture of the lateral tibial plateau IV, fracture of the medial tibial plateau V, bicondylar fracture (can be T or Y shaped) VI, bicondylar fracture with metaphyseal/diaphyseal association...

A lateral dislocation causes damage to the medial patello-femoral ligament and vastus medialis obliq-uis. It can also cause an osteochondral fracture from either the lateral femoral condyle which may be sheared of by the patella or alternatively there may be an avulsion of the medial facet of the patella. 

Radiographs can identify associated avulsion injuries, such as Pelegrini-Stieda lesions (avulsion of the medial femoral condyle at the origin of the medial collateral ligament) and Segond lesion (avulsion fracture of the lateral tihial plateau). Segond fractures are associated with LCL, ACL and meniscal tears (Sferopoulos et al. 2006). 

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