Condyle fracture management pdf

Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Radiologic and clinical spectrum of occipital condyle fractures. A perpendicular line through the sigmoid notch to the ascending ramus1 diacapitular through the head of the condyle fracture. The fracture can be underestimated on plain films and may be seen as a small sliver of bone adjacent to the proximal border of the capitellum. Occipital condyle fractures are traumatic injuries that involve the craniocervicaljunction ccj approximately % of population with blunt craniocervical trauma. Occipital condyle fracture should be suspected when paralysis of the 9th through the 12th nerves colletsicard syndrome occurs after minor head trauma. Arthroscopic management of a posterior femoral condyle hoffa fracture. Fractures of the condylar process account for between 25% and 35% of all mandibular fractures.

The primary goals in the management of mandibular fractures are restoration of functional occlusion and facial form. Closed treatment of mandibular fractures with maxillomandibular fixation mmf has a long and successful history. Delayed management of fracture of the lateral humeral condyle in children kuldip singh dhillon, subir sengupta and bhupinder jeet singh2 frt ynine displaced fractures of the lateral humeral condyle in children were followed for an average of 5 25 years. Clinicians are generally agreed regarding the treatment of fractures in most regions of mandible. Lateral condyle fracture pediatric pediatrics orthobullets. For each type of condylar fracture, the techniques must be. Apr 11, 2017 lateral condyle fractures tend to heal more slowly than other physeal fractures, especially when they are treated nonoperatively. Diagnosis, management and complications of distal humerus lateral condyle fractures in children daniel a shaerf, ivor s vanhegan, rupen dattani, 2018. While a diagnosis can occasionally be made with plain xray, modern ct scans are more accurate. The most common area of fracture is at the condyle 36%, body 21%, angle 20% and symphysis 14%. Pdf management of mandibular condyle fractures bach le. Treatment options for fractures of the condyles consist of either the closed method or by open reduction with fixation. However, the overlap of structures may impair a proper interpretation of images 2. Ct is the best modality for identifying an occipital condyle fracture 6.

Occipital condyle fractures are rarely evident by xray 5,6. Lateral condyle fractures pediatric orthopaedic society. Sagittal or vertical fractures of the mandibular condyle and chip fractures of the medial part of the condylar head are rarely. When a blow to the mandible causes a fracture there are often other fractures too and these must be sought. Humeral condylar fractures and incomplete ossification of. Nonsurgical treatment of condylar fracture in an 11yearold patient. Arthroscopic management of a posterior femoral condyle.

The results were evaluated from functional and cosmetic aspects. The commonly accepted and generally agreed upon aim of treatment is the restoration of the pretraumatic function of the masticatory system. Introduction fractures of the lateral condyle of the humerus comprise 18. Final radiograph and clinical range of motion at 1 year c and d. While it appears that many condylar fractures can be managed nonsurgically, recognition of cases that require surgical intervention and selection of an appropriate procedure are paramount to. Describe initial evaluation and management identify common fracture patterns.

Condylar fracture repair metro atlanta educational society for. Pdf the incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial find, read and cite. Surgical treatment of adult mandibular condylar fractures provides. Occipital condyle fracture radiology reference article. In about 60% of cases the break occurs in two places. Introduction to the guidelines for the management of acute cervical spine and spinal cord injuries. There is a subclassification into deep, medium and high condylar process fractures. Since zide and kent 1 reported the relative and absolute indications of mandibular condyle fracture in 1983, open reduction via surgery has become controversial, and the new approaches of surgical reduction and fixation have. Management of mandibular condyle fractures is controversial. The injury mechanism a traumatic injury in the leg just above the knee, potentially caused by a headon auto accident, has the ability to cause a femoral condyle fracture.

Trauma to one side often produces an ipsilateral body fracture and a contralateral subcondylar fracture. Fractures are best visualized on coronal and sagittal reformatted images. Open reduction and fixation was done after 6 weeks b. Mandibular fractures are sites described as in the horizontal mandible or the dentoalveolar fractures and the vertical mandible with fractures of the mandibular angle, ramus, condyle, and coronoid processes. In case 2, we visualized the condylar fracture in the right side figure 2a from 2dct. There are frequently several appropriate techniques available for the definitive management of a given mandible fracture. Interventions for the treatment of fractures of the. Type b fractures are subclassified based on the involved condyle. Lateral condyle fractures are the second most common elbow fracture after the supracondylar humerus fracture in children. The main causes of condylar fractures include road traffic accidents approximately 50%, falls 30%, and interpersonal violence 20%. Only one patient had plainfilm findings remotely suggesting a condyle injury. Fracture separation of the medial humeral condyle in a child confused with fracture of the medial epicondyle. Intracapsular fractures of the mandibular condyle and fractures in the high portion of its condylar.

Physiotherapy is very important during the rehabilitation following a. Establishing a protocol for closed treatment of mandibular. Coronoid process fractures condylar fractures with minimal occlusal disturbance. Diagnosis of fracture of the occipital condyle requires a high index of suspicion and highresolution tomography. Current concepts in the mandibular condyle fracture management part i. They are a completely different entity to a lateral epicondyle avulsion fracture where the ossification center is avulsed epidemiology. Its long axis is directed medialward and slightly backward. A heavy blow to the symphysis produces a symphyseal fracture and bilateral subcondylar fractures. Jan 23, 2017 operative management will often depend upon whether the fracture is intraarticular or extraarticular in nature. Initial data was extracted from a dedicated trauma database. If there is a fracture break in part of the condyle, this is known as a fracture of the femoral condyle. In 1883, stimson first described the fracture patterns in lateral condyle fractures in his book treatise on fractures. Occipital condyle fracture ocf can be difficult to diagnose, since plain radiographs of the skull and cervical spine often fail to reveal any abnormality. The condyle presents an articular surface for articulation with the articular disk of the temporomandibular joint.

The complications of these fractures are also discussed, including the management of fracture nonunion. Guidelines for the management of acute cervical spine and spinal cord. The milch type i could be considered as a variant of the salterharris type iv physeal injury, while the milch type ii fracture is equivalent to a salterharris type ii physeal fracture. Nondisplaced fractures can then be casted in a long arm. This combination of valgus and compression seems to occur in middleaged people who fall short distances. Tibial plateau fractures orthopaedic trauma association ota. Delayed management of fracture of the lateral humeral. Lateral condyle, delayed, surgical management, paediatric. This age group is more likely to develop ankylosis due to the condylar fracture. A femoral condyle fracture is a potentially serious bone.

Seven year old boy with a displaced lateral condyle fracture fracture line can be observed just proximal to the growth plate above the capitellum. Methodology of the guidelines for management of acute cervical spine and spinal cord injuries. Current concepts in the mandibular condyle fracture. Diagnosis, management and complications of distal humerus. The fracture through the lateral condyle will have a large cartilaginous component as well as the small osseous portion. 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. Since zide and kent 1 reported the relative and absolute indications of mandibular condyle fracture in 1983, open reduction via surgery has become controversial, and the new approaches of surgical reduction and fixation have been introduced and developed. Interpretation of mandibular condyle fractures using 2d and. There are two condyles on each leg known as the medial and lateral femoral condyles. Fractures of the condylar head are referred to as intraarticular or diacapitular fractures. Condylar fracture an overview sciencedirect topics. Surgical approaches preauricular approach alkayat bramley rowes extension obwegesers modification hockey stick retromandibular approach submandibular approach bicoronal.

A femoral condyle is the ballshape located at the end of the femur thigh bone. The fracture line starts above line a, and in more than half the fracture distance runs above line a. Any mandible fracture which transects a dental socket should be considered an open fracture with oral contamination. Summary we report a new intermaxillary fixation imf method for condylar fractures using a thermoforming plate. Mandibular fractures in children and adults need different treatment approaches. Humeral condylar fractures and incomplete ossification of the humeral condyle in dogs andy moores a fiveyear old springer spaniel that was treated for an intercondylar y fracture in practice 2006 28, 3997 humeral condylar fractures classification. The treatment is completely functional for both unilateral and bilateral condylar fractures. Management of lateral humeral condylar mass fractures in. Medial condyle fractures involve a fracture line that extends through and separates the medial metaphysis and epicondyle from the rest of the humerus see image below. Rarely they may be due to osteonecrosis or tumors in the bone. Diagnosis and management of occipital condyle fractures. Tibial plateau fractures are notoriously difficult to manage, particularly when there is a medial or posteromedial component. Fracture treatment concerns include malocclusion, infection, joint.

Data on demographics, etiology, fracture type, and treatment were recorded. This article discusses the management of humeral condylar fractures and iohc. Condylar fractures account for 20% to 62% of all mandibular fractures. Most condylar fractures are a result of blunt trauma to the anterior mandible. While it appears that many condylar fractures can be managed nonsurgically, recognition of cases that require surgical intervention and selection of an appropriate procedure are paramount to success in treating these injuries. This can include a fall onto the chin or a hit from the side.

Overview of condylar fracture article pdf available in archives of plastic surgery 394. Closed reduction fracture is reduced by manipulating the bone without exposing the fracture site by manipulation by traction using elastics. The emergency management of injured dentition was outlined in the pathophysiology section. Fractures of the mandibular condyle quintessence publishing. Intraarticular fractures can be further subdivided into lateral pole fractures, medial pole fractures, condylar head fractures contained within the capsular ligament fig. With any of these three, the fracture line may extend through the neck of the fibula. Initially a combined specialty of eye, ear, nose, and throat.

Delayed management of fracture of the lateral humeral condyle. A bone fracture at this location is termed a femoral condyle fracture. Unicondylar fractures of the lower end of the femur are uncommon injuries that usually occur in the sagittal plane. Treatment protocol for different types of condylar fracture. Mandibular condylar fractures are the most common that account for nearly 20%62% of all the mandibular fractures. Fractures of the lateral humeral condyle capitulum occur as abnormal compressive forces are directed upward through the radius. Type a2, a3, and c2 fractures involve metaphyseal comminution, whereas type c3 fractures are characterized by metaphyseal and intraarticular comminution. The condyle shears off the intercondylar area through the supratrochlear foramen and the lateral supracondylar ridge. Overview pediatric lateral condyle fractures are the second most common fractures in the pediatric elbow and are characterized by a higher risk of nonunion, malunion, and avn than other pediatric elbow fractures.

Management of lateral humeral condylar mass fractures in children. Jan 03, 2019 in 1883, stimson first described the fracture patterns in lateral condyle fractures in his book treatise on fractures. Forces are transmitted to the condylar region, where posterior movement of the mandible is limited by the glenoid fossa, the tmj capsule, and insertion of the lateral pterygoid muscles. In general, the treatment algorithm is based on patient age, unilateral vs bilateral subcondylar fractures, presence of associated fractures, axial inclination of the condylar head 35, level of fracture in the ramus, intracapsular head fractures, dislocation of the condyle from the confines of the glenoid fossa, vertical shortening 5 mm. This image permitted only the visualization of anterior bone displacement of the condylar fracture. In this report, we describe the diagnosis and management of the three patients in our series and make general recommendations regarding the management of patients sustaining this rare injury.

Imf may be required for a period of 7 to 10 days in case of extreme pain. Requires repeat xray every 35 days for first 710 days to confirm fracture remains nondisplaced. Surgical treatment has primarily focused on condylar neck fractures. On the lateral view, a minimally displaced fracture appears as a second line visible above capitellum. Resident manual of trauma to the face, head, and neck. Guidelines for the management of acute cervical spine and spinal cord injuries. Management of condylar fractures linkedin slideshare. This is due to the anatomic complexity of the condyle, the extensive attachments, and its contribution to the temporomandibular joint. The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. By definition, the fracture line must involve the trochlear articular surface.

Closed treatment of condylar fractures by intermaxillary fixation with. Conventional radiographs are routinely used for the examination of this site. He described the fracture as beginning in the lateral metaphysis proximal to the condyle, coursing distally, and exiting through the articular surface through the medial trochlear notch or through the capitellotrochlear groove. Treatment of mandibular condylar process fractures. This fracture pattern is typically through the lateral metaphysis extending into the epiphysis and often extends into the articular surface.

These fractures are divided into three types see box 14. Fracture of the medical condyle of the humerus with rotational displacement. It may result in a decreased ability to fully open the mouth. Humeral condylar fractures are among the most common fractures seen in dogs and account for approximately 20 per cent of the authors canine fracture caseload, although this is a referral population and probably does not represent the true incidence of these injuries. These patients should be on antibiotics and undergo fracture fixation as soon as possible. However, different systems of classification of these fractures make any comparison of treatment results. Classification and management of condylar fractures is a controversial topic in maxillofacial trauma. In addition, a manual search of oral and maxillofacial. The best view to see the lateral condyle fracture is an internal oblique and this. Facial fracture management handbook mandible fractures.

Some nondisplaced or minimally displaced fractures may be managed with casting. Rehabilitation guidelines for tibial plateau fracture 4 p a g e cardiovascular exercises treadmill running, bike, ube progression criteria independent with hep passing score on return to sport test with low risk of reinjury reported return to sport references. Humeral condylar fractures and incomplete ossification of the. Management of condylar process fractures request pdf.

Available in portable document format pdf from the neurosurgery web site. Pdf the treatment of condylar process fractures has generated a great deal of discussion and controversy in oral and maxillofacial trauma and there. Lateral humeral condyle fractures are usually simply termed lateral condyle fractures. Fractures of the medial tibial condyle alone are seen much less frequently, being caused by a varus force on the straight knee. A study on open versus closed reduction of mandibular. The incidence of the functional loss of the range of motion of the elbow is much greater with fractures of the lateral condylar physis. Lindahls classification of mandibular condyle fractures is a complex but commonly used system. Because the patient was unable to bear weight on his right lower extremity or flex his right knee to 90, the physical therapist ordered radiographs of the right knee, 2 which demonstrated a fracture of the lateral femoral condyle posteriorly. Management of condylar fractures remains a source of ongoing controversy. Sep 20, 2014 lateral fracture dislocation of the condyle compound fracture of the condyle like that due to gun shot wounds or invasion by other foreign objects 19. Oct 23, 2008 the treatment of condylar process fractures has generated a great deal of discussion and controversy in oral and maxillofacial trauma and there are many different methods to treat this injury. The treatment of condylar fractures international journal of medical. Delayed operative management of fractures of the lateral. Mandibular condyle fractures are a common type of facial fracture in children.

Mandibular fractures are typically the result of trauma. Several factors are associated with the higher incidence of lateral versus medial condylar fractures. The treatment for tibial plateau fractures aims to achieve anatomical reduction of the joint surface and stable osteosynthesis in order to enable early mobilization, so as to prevent complications such as joint stiffness. Lateral humeral condyle fracture radiology reference.

Pdf treatment of mandibular condylar process fractures. When the 3dct technique was used, we observed the anterior and medial bone displacement of the condylar fracture figure 2bd. Management of condylar fracture varies from case to case. Mandibular condyle fracture is the most common fracture among mandibular fractures, the treatment methods for mandibular condyle fracture have been controversial. None of the clinical symptoms or signs suggesting cervical injury raised suspicion of a condylar fracture. The mandible is an active mobile articulation with the maxillary dentition. The authors aimed to examine the demographics, etiology, treatment, and outcomes of these fractures managed in a single pediatric trauma unit.