Tibial Condylar Fractures: the Late Results of Conservative Treatment.

IT is generally accepted that fractures into joints must, if possible, be afforded perfect reduction, and that when accurate reduction has not been achieved, some considerable stiffness and degenerative arthritis may confidently be expected. This was once commonly illustrated by the malunited fracture-dislocation of the ankle, and incongruities of the scaphoid, olecranon and acetabulum provoke early wear of their respective joints. An exception to this general rule is the tibial condylar fracture, which may be treated by skeletal traction and early movement with justifiable optimism. The lateral tibial condyle is fractured when a valgus force acts on a knee through which weight is being taken, causing the corresponding femoral condyle to be driven downwards into the tibia. This combination of valgus and compression seems to occur in middle-aged people who fall short distances. The term "bumper fracture" or "fender fracture", introduced by Cotton and Berg in 1929, misstates the cause more often than not, and but for its useful brevity could well be discarded. Both the radiographic appearances and the mechanics of the fracture have in the past suggested problems in treatment which have divided surgeons into two distinct schools, namely, those who recommend open reduction and internal fixation, and those who are content to rely on closed methods. Three types of lateral condylar fracture are customarily recognised, according to the classification of Palmer (1951). (1) A vertical fracture splits off a wedge of lateral condyle, which may be little displaced, or displaced downwards and outwards. This type is most amenable to simple closed reduction, and also provides the simplest condylar fracture for internal fixation. (2) There is a variable degree of compression of the lateral tibial plateau; a radiographic