The femur (Latin femur, osfemoris) is the largest tubular bone of the human skeleton. It has the shape of a cylinder, slightly curved in front. For attachment of muscles, a lineaaspera, a rough line, passes along its back surface. In the lower part, the body of the bone is slightly expanded and ends with 2 pineal thickenings - the condyles of the femur.
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 medial medial condyle of the femur and the outer lateral. The lower part of the knee joint forms the tibia, which also has 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 sliding of the hip during flexion and extension of the knee.
By their structure, the condyles of the femur are spongystructure and semicircular shape. As a result, they are fragile. Another minus of sponginess is that in case of fractures, crushing of the bone and the occurrence of a depressed or impression fracture are possible.
What other local pathologies can be in the condyles of the femur? The most common are, of course, injuries, osteoarthritis, osteochondritis, osteomalacia, Koenig's disease, osteonecrosis, bone cyst, congenital deformities and other general pathologies.
Osteonecrosis of the femoral condyles
Osteonecrosis is the death of bone cells (osteocytes) and bone marrow tissues as a result of impaired blood supply to the bone. Its other name is ischemic osteonecrosis (OS). 70% of patients are elderly 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 dysfunction of the knee joint. Pathology ranks third among bone osteonecrosis. The functionality of the knee joint is reduced and pain occurs. In the absence of treatment, the joint is completely immobilized, and then prosthetics may be needed. In the knee joint, osteonecrosis is more common in women.
Stages of pathology:
- No symptoms.
- 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 traumaticetiology (fractures) a specific joint suffers; with non-traumatic - the joints are affected symmetrically in places of maximum load. Non-traumatic factors are 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:
- alcoholization;
- smoking;
- drugs;
- chemo-radiation therapy;
- anemia;
- caisson sickness;
- autoimmune processes in connective tissues;
- hypercholesterolemia;
- tumor processes;
- gout.
Symptomatic manifestations
At the initial stage, there are no symptoms for several months. The process continues to progress, and with the deterioration of the tissues of the joint, a sudden sharp pain arises and then increases. First, it appears during movements in the joint, then remains at rest. As the process progresses, it increases. The joint is initially limited in movement, later it 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 for the bone to recover on its own. With osteonecrosis of the lateral condyle of the femur, if it is possible to walk without relying on a sore leg, orthopedic devices (crutches, orthoses, etc.) are used.
Analgesics are used to relieve pain. Treatment is initially conservative, and only ifits inefficiency perhaps operational:
- Decompression - to reduce pressure in the joint, holes are created in it. Recovery occurs in 65% of cases.
- Transplantation, autografting and osteotomy are rarely used.
- Arthroplasty - the replaced knee joint performs its motor function completely. Its service life is 15 years.
Chondromalacia
Chondromalacia of the articular surfaces of the heads of the bones is a softening of the cartilage in the knee joint; 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 displacement of the condyles in the knee joint;
- injuries;
- bursitis and synovitis;
- vascular disease (atherosclerosis, endarteritis obliterans, varicose veins);
- wrong choice of shoes; rheumatism;
- Ankylosing spondylitis;
- bone calluses in places of fractures and cracks, etc.
In most cases, one head of the bones that make up the joint is affected. This is due to the uneven distribution of loads during joint movement.
Early stages of cartilage pathology occur without any symptoms. This often becomes the reason for the need for surgical treatment in the future. ATthe 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. She can receive nutrition only by diffuse exchange from nearby muscle fibers.
Under the articular cartilage there is always an end plate - this is the end of the epiphysis of the bone, richly innervated and supplied with blood. With increased weight, she also experiences increased pressure. There is also compression of the muscle fibers. The nutrition of hyaline cartilage is disturbed. In the first stage, the cartilage begins to soften and swell. As the process progresses, the synovial membrane is gradually dehydrated, it can no longer instantly and quickly straighten out during physical exertion, and, if necessary, shrink.
At the initial stage, chondromalacia of the condyle of the femur can manifest itself as mild pain in the area above the knee after unusual physical activity. This continues for several years. As a result, the volume of synovial fluid decreases.
As a result of this, the heads of the bones lose their position stability in the joint capsule and begin to move randomly. This further increases the pressure in the joint. The cartilage begins to disintegrate and thin, divides into parts and cracks. This is the second stagechondromalacia. Among its manifestations:
- frequent knee pain, difficulty going up and down stairs;
- crunch when moving;
- frequent periods of inflammation and swelling in the knee;
- limping.
Chondromalacia grade 3 of the condyle of the femur is characterized by complete or partial exposure of the heads of the bones, when the cartilage on their surface begins to be replaced by coarse bone growths. Cartilage is divided into fibers in several layers. The gait becomes duck. Everything ends with deforming osteoarthritis of the knee joint.
In the fourth stage, the destruction of cartilage reaches the bone. Due to the deformation of the cartilage by 1-2 cm, the leg is shortened 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, flat feet and lower leg deformity.
Causes of fractures
Based on the strength of the injury, low- and high-energy fractures are distinguished. The first type occurs when falling from a height of one's own height. Inherent in the elderly, because their bones often already suffer from osteoporosis.
High-energy ones are associated, for example, with a bumper crashing into the knee joint area, a fall from a great height with improper foot placement, and sports injuries. Comminuted fractures are more common, and they usually occur in young people. They can also be partial, incomplete (crack) and complete.
Injuries happendirect and indirect. Direct knee injury is the result of, for example, a blow to the knee from the side, front, hitting the dashboard of a car in an accident, falling on the knee; indirect - falls from a height.
The lateral lateral condyle of the femur is most commonly affected. In second place is a fracture of both condyles. And the medial rarely suffers.
Y-shaped fracture that occurs in trauma when there is damage to the condyles of the femur, appears when falling from a great height, when the legs are straightened and the feet hit the surface first; when hitting the knees in an accident. The bone surface is crushed into many fragments.
The lateral condyle of the femur breaks in a strong side impact, when falling on the knee. Any fracture is always accompanied by severe pain at the time of impact. It will be present at rest and when moving. 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 twisted to the side. If the medial condyle of the femur is damaged, it deviates inward (varus deformity), the lateral one - vice versa (external, or valgus deformity).
When both condyles are fractured, the leg is shortened. The knee joint becomes swollen and reddened, edema develops, and often hemorrhages in it. Movement is practically impossible due to pain. Pathological lateral mobility of the joint appears.
To diagnose a fracture of the condyles of the femur, an X-ray examination is used in 3projections: anteroposterior, lateral, oblique.
CT used for clarification. The main rule for any fracture is to immobilize the leg and immobilize it. Next, you need to call an ambulance. You cannot bring the victim to the hospital yourself, because you will not be able to ensure the correct position of the leg.
With unbearable pain, you can give analgin. It can be useful to distract the victim from the pain with some 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 injecting novocaine.
After that, a plaster with a window is applied to the joint in case a second puncture is necessary. The patient will stay in a cast for up to 1-1.5 months. Then they take another x-ray to check the fusion of the bones. Only after that it is possible to carry out rehabilitation measures.
Movement throughout this period is allowed only on crutches. After 3 months or even later, the load on the joint will be allowed.
Permanent traction
In case of a fracture without displacement, the medial condyle of the femur or the lateral can be affected - there is no fundamental difference. In the tissues of the condyle, a defect occurs in the form of a crack. The injured leg is slightly bent at the knee and placed on a Beler splint. It is used to treat leg fractures by skeletal traction, which is carried out by passing a needle through the calcaneus, after which it is suspended on it.load weighing 4-6 kg. In this position, the patient is also 4-6 weeks. A plaster bandage is also applied for several weeks. The load on the affected area is allowed no earlier than after 4 months.
Surgical treatment
Surgical intervention is used for a fracture with displacement (more often the outer condyle of the femur breaks). It is performed under general anesthesia 3-7 days after the injury.
An incision is made on the knee and all unnecessary consequences of the fracture in the form of blood, fluid, fragments that cannot be repositioned are removed through it.
Intra-articular fractures with displacement - a category of severe injuries, in which it becomes very important to restore the articular surface as accurately as possible, eliminating the displacement of fragments. This is necessary because after such fractures, osteoarthritis easily develops - the most severe complication.
If there is a spall, grasp the internal condyle of the femur and attach to the bone with a long screw, setting it in place. Apply open reduction with internal fixation. A comminuted fracture is often accompanied by internal bleeding.
X-rays are taken to reveal the movement of fragments. The patient is then placed in skeletal traction. Plaster cast - 1.5 months. The functionality of the joint will not be restored until 4 months after the fracture.
Removal of metal elements occurs one year after the preliminary re-X-ray.
If it happenedan impression fracture of the condyle of the femur, in which its spongy tissue is crushed, an operation of transosseous osteosynthesis is performed. The screws are useless here. The displaced and depressed condyle is manually repositioned and fixed with traction. Sometimes it becomes possible to use a pin - an intraosseous rod with screws.
Rehabilitation and prognosis
Rehabilitation begins only after the cast is removed - this is massage, exercise therapy, physiotherapy. Possible complications of condylar fractures are chondromalacia and osteochondritis dissecans, osteoarthritis.
Chondromalacia is a lesion of cartilage with its thinning and destruction. With osteochondritis dissecans (Koenig's disease), the cartilage first softens 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 intra-articular fracture, but also in the distal part of the femur itself, provided that its biomechanical axis is disturbed. The axis is important because it ensures the correct distribution of the load in the knee joint. However, intra-articular fractures of the lateral or medial femoral condyle very often lead to post-traumatic osteoarthritis. It does not proceed so harmlessly and, in turn, is accompanied by pain, limitation of movement and instability of the joint.
Bone cysts
Cyst is a cavity formation filled with fluid. It is considered a benign neoplasm. A typical place of formation is long tubular bones.
B60% it occurs in the shoulder girdle, and only in 25% of cases there is a cyst of the condyle of the femur, collarbone, sternum, pelvis, jaw and skull (as it decreases). According to statistics, bone cysts occur in children aged 10 to 15 years. It rarely occurs in adults, mostly in young men under 30.
Causes and risk groups
The causes of cysts have not been established even today. There are only concepts that suggest a lack of nutrients and oxygen as a causal factor.
The main causative factors in such cases are:
- osteomyelitis, arthritis;
- pathology of embryogenesis;
- degenerative process:
- osteoarthritis;
- fracture, injury.
Modern views on the development of bone cysts are 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 content, a bone cyst can 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, affects mainly girls and girls aged 10 to 20 years, most often affects the spine.
Symptoms of pathology
A bone cyst exists for a very long time without any symptoms - up to several years. This is because it grows very slowly.
The first signs are strongparoxysmal pain, dependent on movements and loads. No pain at rest.
Next appear:
- palpation tenderness of soft tissues over the area of the cyst and swelling;
- work and adjacent joints are disturbed;
- affected bone increases in size;
- if the bone is close to the surface of the skin, palpation of the cyst is visible.
X-ray, CT or MRI is done for diagnosis. To identify the contents of the cyst, it is punctured, and its treatment also depends on it. The choice of treatment depends on the age of the patient. The child is undergoing only conservative treatment.
Operations are undesirable as the skeleton is growing. Children after a bone cyst recover very quickly, and in 90% of cases there is a cure. They rarely have relapses. Prevention of cysts does not exist, since the causes of their occurrence have not been identified.
