The femur (lat. Femur, osfemoris) is the largest tubular bone of the human skeleton. It has the shape of a cylinder, slightly curved in front. To attach the muscles along the back of its surface runs lineaaspera, a rough line. In the lower part, the body of the bone is slightly widened and ends with 2 pineal-shaped thickenings - the femoral condyles.
The structure to the condyles is cortical, that is, it is a tube with thick walls. The lower end of the thigh 2 with its condyles passes into the upper part of the knee joint - the internal medial condyle of the femur and the external lateral. The lower part of the knee joint forms the tibia, also having 2 condyles.
The front of the knee joint is formed by the patella. On the condyles of the femur are the articular surfaces necessary for articulation with the patella and tibia. Outside, they are covered with cartilage, which ensures smooth hip sliding during flexion and extension of the knee.
In structure, the femoral condyles have a spongy structure and a semicircular shape. Due to this, they are fragile. Another minus of the spongy is that during fractures, crushing of the bone and the appearance of a depressed or impression fracture are possible.
What other local pathologies can be found in the femoral condyles? The most common are, of course, injuries, osteoarthritis, osteochondritis, osteomalacia, Koenig's disease, osteonecrosis, bone cyst, congenital deformities and other general pathologies.
Hip condyle osteonecrosis
Osteonecrosis is the death of bone cells (osteocytes) and bone marrow tissue as a result of a violation of the blood supply to the bone. Its other name is ischemic osteonecrosis (OS). 70% of patients are older women over 60.
In this case, in 96% of cases, the condyles are affected, and only in 6% of cases - the patella. Frequency - 20% of all cases of knee dysfunction. Pathology ranks third among osteonecrosis of bones. The functionality of the knee joint is reduced and pain occurs. In the absence of treatment, the joint is completely immobilized, and then prosthetics are necessary. In the knee joint, osteonecrosis is more common in women.
Stages of pathology:
- Symptoms are absent.
- Sclerotic changes and cysts occur.
- The joint takes the shape of a crescent.
- The joint is deformed.
Causes of pathology
The causes of degeneration are divided into traumatic and non-traumatic. With traumatic etiology (fractures), a particular joint suffers; with non-traumatic - joints are affected symmetrically in places of maximum load. Non-traumatic factors are the excessive entry into the bloodstream of the chemical components of various drugs (hormonal drugs, NSAIDs, corticosteroids), as well as intoxication of the body, inflammatory processes, intra-articular injections.
Risk factors:
- alcoholism;
- smoking;
- drugs
- chemo and radiation therapy;
- anemia;
- decompression sickness;
- autoimmune processes in connective tissues;
- hypercholesterolemia;
- tumor processes;
- gout.
Symptomatic manifestations
At the initial stage, for several months there are no symptoms. The process continues to progress, and with the deterioration of the state of the tissues of the joint occurs, and then sudden sharp pain increases. First, it appears during movements in the joint, then it remains at rest. As the process progresses, it grows. The joint is initially limited in movement, later - does not work at all.
Treatment
Among the first measures, maximum unloading of the joint is recommended. If the defect is small, this is enough to restore the bone on its own. With osteonecrosis of the lateral condyle of the femur, if it is possible to walk without resting on a sore leg, use orthopedic devices (crutches, orthoses, etc.).
Analgesics are used to relieve pain. The treatment is conservative at first, and only if it is ineffective is surgery possible:
- Decompression - holes are created in it to reduce pressure in the joint. Recovery occurs in 65% of cases.
- Transplantation, autotransplantation and osteotomy are rarely used.
- Endoprosthetics - the replaced knee joint performs its motor function completely. Its service life is 15 years.
Chondromalacia
Chondromalacia of the articular surfaces of the bone heads is a softening of the cartilage in the knee joint; a common problem in obesity. Also at risk are extreme lovers with a very active lifestyle, with a predominance of traumatic sports to maintain tone.
Other reasons:
- hereditary disorders at the gene level;
- hypokinesia, flat feet and clubfoot, in which there is an incorrect setting of the feet, leading to the displacement of the condyles in the knee joint;
- injuries
- bursitis and synovitis;
- vascular diseases (atherosclerosis, obliterating endarteritis, varicose veins);
- the wrong choice of shoes; rheumatism;
- Ankylosing spondylitis;
- bone marrow in places of fractures and cracks, etc.
In most cases, one head of the bones making up the joint is affected. This is due to the uneven distribution of loads during joint movement.
The early stages of cartilage pathology occur without any symptoms. This often becomes in the future the reason for the need for surgical treatment. In the initial stage, with proper treatment, the integrity of the cartilage can be fully restored.
Causes of Chondromalacia
Chondromalacia is a change in the condyles of the femur in the form of a degenerative process that begins with a violation of the blood supply to the muscle fiber surrounding the knee joint. Cartilage itself does not have its own network of capillaries. It can receive nutrition only by diffuse exchange from adjacent muscle fibers.
Under the articular cartilage is always an end plate - this is the end of the pineal gland, richly innervated and supplied with blood. With increased weight, she also experiences increased pressure. There is a squeezing of muscle fibers. Disturbed hyaline cartilage nutrition. In the first stage, the cartilage begins to soften and swell. The synovial membrane is gradually dehydrated as the process progresses, it can no longer instantly and quickly straighten out during physical exertion, and if necessary, contract.
At the initial stage, chondromalacia of the femoral condyle can manifest as mild soreness in the area above the knee after unusual physical exertion. This continues for several years. As a result, the volume of synovial fluid decreases.
As a result, the bone heads lose their stability in the joint capsule and begin to move randomly. This further increases the pressure in the joint. The cartilage begins to decay and thin out, is divided into parts and is cracked. This is the second stage of chondromalacia. Among its manifestations:
- frequent knee pain, difficulty climbing and descending stairs;
- crunch during movements;
- frequent periods of inflammation and swelling in the knee;
- lameness.
Chondromalacia of the 3rd degree condyle of the femur is characterized by complete or partial exposure of the heads of bones, when the cartilage on their surface begins to be replaced by rough bone growths. Cartilage is divided into fibers in several layers. Gait becomes duck. It ends with a deforming osteoarthrosis of the knee joint.
In the fourth stage, cartilage destruction reaches the bone. Due to cartilage deformation of 1-2 cm, a shortening of the leg occurs on the affected side. Independent movement becomes impossible. There is a need for joint replacement.
Chondromalacia of the medial condyle of the femur can lead to the development of clubfoot, flatfoot and deformation of the lower leg.
Causes of Fractures
By the strength of the injury, low- and high-energy fractures are distinguished. The first type occurs when falling from a height of its growth. Inherent in the elderly, because their bones often already suffer from osteoporosis.
High-energy ones are associated, for example, with bumping into the area of the knee joint, falling from a great height with incorrect legs, and sports injuries. Shattered fractures are more common, and they usually occur in young people. They can also be partial, incomplete (crack) and complete.
Injuries can be direct and indirect. A direct knee injury is the result of, for example, hitting a knee from the side, front, hitting a car dashboard in an accident, falling to the knee; indirect - falls from a height.
Most often, the external lateral condyle of the femur suffers. In second place is a fracture of both condyles. And very rarely does the medial suffer.
A Y-shaped fracture that occurs when an injury occurs when the femoral condyles are damaged, appears when falling from a great height, when the legs are straight and the feet are the first to collide with the surface; when hitting the knees in an accident. The bone surface is divided into many fragments.
The lateral condyle of the femur breaks with a strong lateral impact, when falling on the knee. Any fracture is always accompanied by severe pain at the time of impact. She will be present at rest and during movement. In addition to it, there is an accumulation of blood above the knee in the spongy part of the condyles. Even touching this area immediately causes pain.
When the condyles are displaced, the lower leg will be turned to the side. If the medial condyle of the femur is damaged, it deviates inward (varus deformity), lateral - vice versa (external or valgus deformity).
With a fracture of both condyles, the leg is shortened. The knee joint becomes swollen and reddened, swelling develops, and often hemorrhage in it. Practical movements are impossible due to pain. Pathological joint mobility appears to the side.
To diagnose a femoral condyle fracture, an X-ray examination is used in 3 projections: anteroposterior, lateral, oblique.
For clarification, CT is used. The main rule for any fracture is the immobilization of the leg and its immobilization. Next you need to call an ambulance. You cannot deliver the victim to the hospital yourself, because you cannot ensure the correct position of the leg.
With unbearable pain, analgin can be given. It is useful to distract the victim from pain by some kind of extraneous conversation.
Conservative treatment
In conservative treatment, the first condition is the removal of blood from the joint cavity (hemarthrosis) with a special syringe with a thick needle after preliminary anesthesia. The joint is then anesthetized by administering novocaine.
After this, gypsum with a window is applied to the joint in case of need for repeated puncture. In a cast, the patient will be up to 1-1.5 months. An X-ray is then repeated to check bone fusion. Only after this is it possible to carry out rehabilitation measures.
Movement throughout this period is allowed exclusively on crutches. After 3 months or even later, the joint load will be allowed.
Constant traction
With a fracture without displacement, the medial condyle of the femur or lateral can be affected - there is no fundamental difference. In the tissues of the condyle, a defect in the form of a crack occurs. A damaged leg is slightly bent at the knee and placed on the Belera splint. It is used to treat leg fractures by the method of skeletal traction, which is carried out by passing a spoke through the calcaneus, after which a weight of 4-6 kg is suspended on it. In this position, the patient is also 4-6 weeks. The plaster cast is also applied for several weeks. The load on the lesion site is allowed no earlier than 4 months later.
Surgical treatment
Surgical intervention is used for a fracture with a displacement (the external condyle of the femur breaks more often). It is carried out under general anesthesia 3-7 days after the injury.
An incision is made on the knee and through it all unnecessary consequences of the fracture are removed in the form of blood, fluid, fragments that cannot be repositioned.
Intra-articular fractures with displacement are the category of severe injuries in which it becomes very important to restore the articular surface as accurately as possible, eliminating the displacement of the fragments. This is necessary because after such fractures, osteoarthrosis easily develops - a very serious complication.
If there is a spall, grab the inner condyle of the femur and attach to the bone with a long screw, replacing it. Apply open reposition with internal fixation. A comminuted fracture is often accompanied by internal bleeding.
An x-ray is taken to detect the movement of the fragments. Next, the patient is on skeletal traction. Plaster cast - 1.5 months. Functionality of the joint will not be restored until 4 months after the fracture.
The removal of metal elements occurs a year after a preliminary repeated x-ray.
If an impression fracture of the condyle of the femur occurred, in which its spongy tissue collapses, an operation of transosseous osteosynthesis is performed. Screws are useless here. The offset and depressed condyle are manually reposed and fixed with traction. Sometimes it becomes possible to use a pin - an intraosseous shaft with screws.
Rehabilitation and prognosis
Rehabilitation begins only after removal of the cast - this is massage, exercise therapy, physiotherapy. Possible complications of condyle fractures - chondromalacia and dissecting osteochondritis, osteoarthrosis.
Chondromalacia is a lesion of cartilage tissue with its thinning and destruction. With dissecting osteochondritis (Koenig's disease), the cartilage softens first in some area, and then it completely exfoliates from the bone, forming an articular mouse. Pathology is quite rare.
Post-traumatic osteoarthritis can develop not only with an intraarticular fracture, but also in the distal part of the femur itself, provided that its biomechanical axis is disturbed. The axis is important because it provides the correct load distribution in the knee joint. Nevertheless, intraarticular fractures of the lateral condyle of the femur or medial very often lead to post-traumatic osteoarthritis. It does not proceed so harmlessly and, in turn, is accompanied by pain, limitation of movements and instability of the joint.
Bone cysts
A cyst is a cavity formation filled with fluid. It is considered a benign neoplasm. A typical place of formation is long tubular bones.
In 60%, it occurs in the shoulder girdle, and only in 25% of cases is the condyle of the femur, clavicle, sternum, pelvis, jaw and skull (in decreasing order). According to statistics, bone cysts occur in children aged 10 to 15 years. In adults, this is rare, mainly in young men under 30 years old.
Causes and risk groups
The reasons for the appearance of cysts have not been established today. There are only concepts that suggest a causative factor in the lack of nutrients and oxygen.
The main causative factors in such cases are:
- osteomyelitis, arthritis;
- embryogenesis pathology;
- degenerative process:
- osteoarthrosis;
- fracture, bruise.
Modern views on the development of bone cysts consist in the fact that nutritional deficiency and hypoxia lead to the activation of lysosomal enzymes that behave autoaggressively. This leads to fluid accumulation and cavity growth.
Types of pathology
Depending on its contents, a bone cyst may be:
- Solitary - filled with liquid, occurs in children. Boys are 3 times more likely to suffer. Large tubular bones are affected.
- Aneurysmal - filled with blood, mostly girls and girls aged 10 to 20 years suffer, most often the spine is affected.
Symptoms of pathology
A bone cyst exists for a very long time without any symptoms - up to several years. This is because it is growing very slowly.
The first signs are severe paroxysmal pain, depending on movements and loads. There is no pain at rest.
Next appear:
- palpation tenderness of soft tissues over the area of the cyst and swelling;
- disrupted work of neighboring joints;
- the affected bone increases in size;
- if the bone is close to the surface of the skin, palpation of the cyst is visible.
For diagnosis, an X-ray, CT or MRI is done. To identify the contents of the cyst, its puncture is performed, and its treatment depends on this. The choice of treatment also depends on the age of the patient. Only conservative treatment is given to the child.
Operations are undesirable as the skeleton is growing. Children after a bone cyst recover very quickly, and in 90% of cases a cure occurs. Relapses are rare. Prevention of cysts does not exist, since the causes of their appearance are not identified.