Date: Mon, 18 Jun 2001 17:06:36 -0400
Subject: Medial Femoral Condyle Malunion
Patient is a 45 yo homeless male that was struck by a car 3 months ago. He had left type 3A open prox tibia fx treated w/ a LISS and no problems in follow up. He also had a left medial femoral condyle fx that was impacted. The MFC had an ORIF and bone grafting, but has gone into varus w/ loss of the MFC reduction. He is now 3 months post injury w/ 15 degrees of varus and ROM of 20-120.
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Any suggestions? Osteotomy (femoral or tibial) vs revision ORIF?
Bill Obremskey MD MPH
University of North Carolina
Dept. of Orthopedics
Date: Mon, 18 Jun 2001 16:54:03 -0500
From: Marc F. Swiontkowski, M.D.
Bill- I vote revision ORIF with ICBG- need longer anterior to posterior screws placed in lag manner. I believe the Hoffa component would remain un-united with a supracondylar osteotomy.
marc
Marc F. Swiontkowski, M.D.
Professor and Head
Univ. of Minnesota Dept. Orthopaedic Surgery
Date: Mon, 18 Jun 2001 17:20:54 -0500
From: Adam Starr
I think if the wounds are well healed I'd try to fix that one again, and buttress my repair with a little plate in addition to the screws.
Adam Starr
Dallas, Texas
Date: Mon, 18 Jun 2001 20:27:27 -0700
From: Janet Chandler
Medial opening wedge supracondylar osteotomy
Date: Tue, 26 Jun 2001 07:25:46 -0600
From: Thomas A. DeCoster
what did you do with the distal femur fracture (medial condyle) that settled after ORIF?
Date: Wed, 27 Jun 2001 16:39:06 -0400
From: William Obremsky
Tom,
I opened his knee and removed the Hardware. The articular surface was smooth and healed. I felt that the entire Hoffa fragment must have settled w/ the distal femora articular surface and healed. A manipulation eliminated the flexion deformity, which I believe was due to posterior capsule contracture. I decided not to do a hemicondyle osteotomy and fixation. He is walking w/ a walker and going back to his tent tommorow. If his knee is a problem in several months, I will do an HTO. Doing a compensatory instead of a corrective osteotomy goes against my grain, but in this case I thought it was best. I do not know yet if I was Chicken or Wise.
Bill Obremskey