[18]. [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. The distal femur is the area of the leg just above the knee joint. Ann Chir 1978;32:2139. We used the key words Hoffa fracture and coronal fracture of femoral condyle for the knowledge. eCollection 2020 Jun. The patellar height was in the normal range (Caton-Deschamp index 1.0). Clipboard, Search History, and several other advanced features are temporarily unavailable. This site needs JavaScript to work properly. Khle J, Angele P, Balcarek P, et al. Nonunion of coronal shear fracture of femoral condyle. 2). J Knee Surg 2008;21:23540. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Intra-articular dislocation of the patella. Arthroscopy 1996;12:2247. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Intertrochanteric femoral fractures account for 3.13% of total adult fractures, 24.56% of femoral fractures, and 50% of proximal femoral fractures (Koval et al. [66]. A rare case of bicondylar. An impact fracture is a form of failure where a metal separates into fragments due to a stress applied at a temperature below the metal's melting point. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. Three days after injury, the lateral parapatellar incision of the right knee was performed under general anesthesia, OCF reduction and fixation of the lateral condyle was performed. 2021. J Orthop Trauma 1999;13:13840. Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature. Your message has been successfully sent to your colleague. This is the first report on a fracture of medial femoral condyle treated with this implant. Careers. [4]. Nandy K, Raman R, Vijay RK, et al. When the patient has patellar dislocation with OCF in the weight-bearing area of LFC, surgical treatment and internal fixation is the treatment of choice if the OCF can be fixed. For more information, please refer to our Privacy Policy. Surgically treated Hoffa Fractures with poor long-term functional results. In reviewing left knee radiographs that had previously been interpreted as normal, the physical therapist noted an abnormally deep depression of the medial condylopatellar sulcus, which was concerning for a possible impacted osteochondral fracture. Westmoreland GL, McLaurin TM, Hutton WC. [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. [7]. Visual observation revealed significant right knee effusion and an inability to bear weight on the right lower extremity or flex his knee beyond 80. Many author think these injuries are caused by the impact between the patella and femoral condyle with a knee flexed over 90. In these cases, magnetic resonance imaging (MRI) can show a lateral femoral notch sign: a depression in the lateral femoral condyle, which could indicate an ACL tear . However, if the tunnel is too close to the distal femoral articular surface and too little cartilage-covered bone is retained, either the passage of the tendon through the bone tunnel or fixation of the tendon can lead to a Hoffa fracture. When patients have tenderness along the medial edge of patella and knee joint effusion, it is necessary to actively improve MRI examination, to rule out osteochondral injury. Gelber PE, Erquicia J, Abat F, et al. Accessibility Valgus strain on the knee and the continuous pull of the quadriceps causes the patella to ride against the femoral condyle, resulting in rotation around its vertical axis. Highlight selected keywords in the article text. Busam ML, Provencher MT, Bach BR. Egol KA, Broder K, Fisher N, et al. Depression Of more than 5 mm in a type 3 fracture can treated by elevation from below and (d' supported by bone grafts and fixation. [77]. In addition to changes in bone mineral composition and a reduced proportion of bone matrix in patients with osteoporosis, changes in bone microstructure, thinning of bone cortex, and reduction in the number and size of bone trabeculae result in a decreased bone load capacity[26] and an increased risk of a Hoffa fracture with low-energy trauma. When high-energy trauma involves the distal femur, the lateral condyle is often damaged[18] before the medial condyle because of the physiologic genu valgum of the knee joint. Sagittal, fat-suppressed, proton density-weighted magnetic resonance image of the left knee demonstrating a focal indentation of the anterior portion of the medial femoral condyle (orange arrow . This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Clinical outcomes after absorbable suture fixation of patellar, [26]. lateral femoral condyle fractures in 80% Angiography indications ankle-brachial index (ABI) <0.9 obvious signs of vascular injury i.e., hard and soft signs (pulselessness, rapidly expanding hematoma, massive bleeding, etc.) Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. Injury 2005;36:8625. (C) Making a small incision on the outside of the knee joint, it is convenient to drill two 2.0mm bone channels from the distal end of the femur from the outside to the intercondylar fossa. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Disclaimer. Arthroscopic; Internal fixation; Osteochondral fracture; Suture anchor; TWINFIX Ti. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. Chauhan A. Irreducible, incarcerated vertical dislocation of the patella into a. [95] Because Hoffa fractures are intra-articular, the success of anatomical reduction and firm internal fixation is closely related to postoperative complications like traumatic arthritis. Pa a et al[17] reported that 10 patients with patellar osteochondral mass less than 2.7mm2 caused by patellar dislocation still achieved good function only by taking out the loose body, and no patellar dislocation was found. Dave LY, Nyland J, Caborn DN. Distal femur fractures most often occur either in older people whose bones . See this image and copyright information in PMC. Please enable it to take advantage of the complete set of features! A modified posterolateral approach for. Tsai et al[103] reported that surgical treatment is the 1st choice for Hoffa fracture accompanied by traumatic patella dislocation; if conservative treatment is adopted, the redislocation rate is as high as 40%. Springerplus 2016;5:1164. (B) AIMER was located at the outlet of the medial bone canal of the lateral condyle of the femur. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. 3). impacted and stress fractures. Rosenberg NJ. FOIA Sun H, He QF, Huang YG, et al. 2013;33:5118. [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. In this paper, three cases of osteochondral fracture of lateral femoral condyle were treated with arthroscopic TWINFIX Ti suture anchor internal fixation, and good results were obtained. Sasidharan B, Shetty S, Philip S, et al. Acta Orthop Belg 2001;67:1328. The .gov means its official. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. Tan Y, Li H, Zheng Q, et al. Medial and lateral buttressing may be required if either fracture extends proximally in the same plane. [98]. Mashoof AA, Scholl MD, Lahav A, et al. Medicine (Baltimore). [11,12] The bone marrow edema at the posterolateral aspect of the LFC suggest that the knee joint is highly flexed during patellar dislocation. J Bone Joint Surg Am 2005;87:5649. This is the first case to apply the suture anchor system to the reduction and fixation of fracture. modify the keyword list to augment your search. 2014;22:238895. [21] Matthewson et al[21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early internal fixation and external fixation to avoid early weight bearing, and achieved good results. [3]. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. Operative, [46]. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. Arthroscopic. Distal pulses and sensation were intact. A case report. Complained of swelling and pain of the right knee after spraining during sports activities, demonstrated painful limited motion. A 15-year-old female student accidentally sprained her right knee while participating in sports activities. (A) Use of anterior cruciate ligament locator to assist drilling at the distal end of the femur. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. your express consent. Hoffa fracture with cruciate ligament, lateral collateral ligament, or meniscus injuries can be treated with arthroscopic surgery,[90] which has the advantages of minimal invasion, less of an effect on blood supply, early postoperative return to functional exercise, and effective prevention of nonunion and joint stiffness. The specific mechanism of a Hoffa fracture is not well understood. [34] The clinical diagnosis of a Hoffa fracture relies on trauma history, physical examination, imaging, and other objective indicators as well as increased suspicion based on the history and positive signs.[35,36]. The main cause of a Hoffa fracture is a high-energy injury such as those sustained in traffic collisions (80.5% of cases) and falls (9.1% of cases). J Bone Joint Surg Am 2008;90:46370. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. Malays Orthop J 2017;11:204. Matthewson et al[10] believe OCF in weight-bearing area of LFC with patellar dislocation is caused by the shearing forces between the LFC and the lateral tibial plateau as they pivot under load. [14]. [50,51] An open supracondylar- intercondylar distal femoral fracture has a 2.8 times more chance of a Hoffa fracture than a closed distal femoral fracture. Antigliding plating for Letenneur type I Hoffa fractures. Epub 2018 Oct 4. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. After the incision was closed in layers, the lower limb was splinted for 6 weeks, isometric exercises for the quadriceps began the day after surgery. Acute patellar dislocation in children and adolescents: a randomized clinical trial. Palmu S, Kallio PE, Donell ST, et al. National Library of Medicine 2012;40:191623. Intra-articular corrective osteotomy for malunited. Before Osteochondral fracture involving the weight-bearing portion of the lateral femoral condyle is relatively rare injury as it involves hyper flexion of the knee at the time of . Arthroscopy 2011;27:81724. [20]. Musculoskelet Surg 2012;96:4954. Report of 20 cases [in French]. Acta Orthop Scand 1997;68:4246. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. [16]. Allmann KH, Altehoefer C, Wildanger G, et al. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. J Orthop Trauma 1994;8:1426. [1]. to maintaining your privacy and will not share your personal information without The exposed fracture line is initially fixed with a k-wire and screws are placed perpendicular to the fracture surface. Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. Surgical diagrams (A: osteochondral fracture of the lateral femoral condyle; B: fixation of fracture block with Kirschner wire; C: fixation of fracture block with anchor; D: preparation of bone tunnel; E: penetration of PDS line and PDS guidance of anchor suture to the outer entrance of femoral tunnel; F: Operation completion diagram). Type 2 fractures require a . [25]. Methods All patients with post-injury bi-plane radiographs and MRI images after sustaining a tear to the anterior cruciate ligament were included. FIGURE 2. Somford MP, van Ooij B, Schafroth MU, et al. Bali K, Mootha AK, Krishnan V, et al. Chin J Traumatol. On lateral radiographs, the normal femoral condyles overlap, and bone cortex interruption may not be visible. A fracture is a broken bone. A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Paa L, Vesel R, Koi J, et al. Radiography can reveal fracture lines. After arthroscopic confirmation of Lateral Femoral Condyle (LFC) ostechondral fracture (HSL, Hill-Sachs-like Lesion) the anterolateral portal is enlarged to 2-3 cm. [56]. The patient felt pain in his right knee and limited movement. J Orthop Surg 2017;25:17. FIGURE 1. [89]. [40]. Knee Surg Sports Traumatol Arthrosc. Malunion: This happens when your broken bones don't line up correctly while they heal. Pathology The likely mechanism is a hyperextension or impaction injury with a collision of the femoral condyle and the posterior tibial plateau during the rotational movement responsible for injuring the ACL, most commonly the pivot-shift. Life (Basel). Knee 2004;11:1257. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. Introduction. An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. The natural history. Singh AP, Dhammi IK, Vaishya R, et al. J Knee Surg 2013;26(Suppl 1):S8993. Shetty GM, Wang JH, Kim SK, et al. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. For bicondylar fractures, a median parapatellar incision can be used. Autologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. osteochondral impaction fracture postsurgical (e.g. findings identifies vascular segments with diminished flow vascular injury One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. Werner BC, Miller MD. Sahu RL, Gupta P. Operative management of, [44]. [57]. [15,16] These forces cause gross displacement of the condyle, which can not only rupture the quadriceps tendon but also perforate the skin, resulting in an open injury. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. [18]. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. Factors of patellar instability: an anatomic radiographic study. Gerdy's tubercle osteotomy for the, [69]. We prospectively documented all potential cases of non-weight-bearing posterior subchondral impaction fractures of the femoral condyles diagnosed on magnetic resonance imaging (MRI) of the knee performed at our institution between January 2006 and December 2011. [3,4] In 1888, Hoffa described coronal fracture of the femoral condyle but did not indicate the source of the previous reference. You may search for similar articles that contain these same keywords or you may [17]. For example, a fracture line dividing the femoral condyle surface into 2 parts is classified as type I; 2 fracture lines dividing the femoral condyle surface into 3 parts is type II; and 3 or more fracture lines dividing the femoral condyle surface into 4 or more parts is type III. Marzouki A, Zizah S, Benabid M, et al. sharing sensitive information, make sure youre on a federal Reconstructive osteotomy for a malunited medial. In types III and IV (unicondylar coronal plane fracture with supracondylar or intercondylar distal femoral fractures, respectively), fixation is needed as for isolated Hoffa fracture in addition to stabilization with a metaphyseal bridging implant or a fixed-angle device. Arthrosc Tech 2015;4:e299303. How to cite this article: Wu L, Liu C, Jiang B, He L. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. Screw insertion direction differs among operative approaches. [10]. Chin J Orthop Trauma 2009;9:8503. [6]. Medicine 2022;101:50(e32104). Hoffa nonunion, two cases treated with headless compression screws. Nakagawa S, Arai Y, Inoue H, et al. 3021 Tibial plateau fractures - fixation (a) Two or three lag screws may be sufficient for simple split fractures (type l), though 'b) a buttress plate ard screws may be more secure. [58]. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. [81] For patients who require a longer healing time, such as those with a higher body mass index or poor compliance, the simple application of a cannulated screw is insufficient to counter the great shearing force between condyles and the tibial plateau when the knee is in flexion. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau.

Which Statement Best States Evidence Given In This Passage, Articles I