Recently, impaction fractures in the non-weight-bearing area of the lateral femoral condyle were reported in 16 of 6600 patients who underwent knee MRI. Please enable scripts and reload this page. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. [36]. The goals of treatment include restoration of function and esthetics. 5 and 6), and the lysholm score was 95 points, which was very good. Surgical versus nonsurgical treatments of acute primary patellar dislocation with special emphasis on the MPFL injury patterns. Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro. [96]. Calmet J, Mellado JM, Garcia Forcada IL, et al. Moreover, even if the medial patellar retinaculum is strengthened, the patient still has symptoms such as anterior knee pain. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. [79]. Epub 2007 Mar 23. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. Technique for Treatment of Subchondral Compression Fracture of the Nonunion of coronal shear fracture of femoral condyle. Materials and methods: This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Zhao LL, Tong PJ, Xiao LW. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. J Knee Surg 2013;26(Suppl 1):S8993. Anterior cruciate ligament tear | Radiology Reference Article 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. Your message has been successfully sent to your colleague. Your message has been successfully sent to your colleague. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd. Xray examination of right knee joint: free bone mass can be seen at, (A) MRI examination of the right knee joint: the bone continuity at the, (A) The fresh 1.5 cm 1.5 cm fracture surface of the lateral, (A) One 1.5 mm Kirschner wire temporarily fixed the fracture block of the, (A) Use of anterior cruciate ligament locator to assist drilling at the distal, (A) Through the hollow needle channel of the femoral intercondylar fossa, the folding, Surgical diagrams (A: osteochondral fracture, Surgical diagrams (A: osteochondral fracture of the lateral femoral condyle; B: fixation of, CT examination 6 months after operation: one screw internal fixation, regular external condyle, (A) A blurred fracture line can be seen at the fracture of the, MeSH This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. Intra-articular dislocation of the patella with associated, [26]. Tripathy SK, Aggarwal A, Patel S, et al. [82,83] A biomechanical study by Li et al[84] demonstrated that plates combined with screws more firmly fixed the femoral condyle, reducing the probability of fracture displacement. Two cartilage masses can be seen during the operation. [33] Dua and Shamshery[34] proposed a classification method that supplements the AO classification with proper surgical planning to optimize outcomes. Please enable it to take advantage of the complete set of features! Bicondylar. Transverse Hoffa's or deep osteochondral fracture? Pathology. Twenty-seven-year nonunion of a. Epub 2022 Nov 15. Factors of patellar instability: an anatomic radiographic study. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. 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. J Knee Surg. (C) CT examination of the left knee joint: the continuity of the subarticular bone of the lateral condyle of the left femur was interrupted. Technique for Treatment of Subchondral Compression Fracture of the Lateral Femoral Condyle Associated With ACL Tear Technique for Treatment of Subchondral Compression Fracture of the Lateral Femoral Condyle Associated With ACL Tear Arthrosc Tech. Treatment of osteochondral fracture of lateral femoral : Medicine [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. 5cm cartilage mass was stripped from nonweight-bearing area of the LFC, and no osteochondral mass was found at the medial edge of patella (Fig. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). We report a case of patellar dislocation with OCF in the weight-bearing area of LFC. [16]. [43]. The patient was referred to an or- thopaedic surgeon, who recommended conservative management. 1986;14:11720. What is an Impact Fracture? - Definition from Corrosionpedia Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. Other structures may be fractured at the same time due to the great forces experienced through the femur bones. [12,37] Orthopedic surgeons treating these patients should be vigilant in diagnosing a Hoffa fracture; patients with undiagnosed injuries experience long-term knee pain and limited knee mobility. [40]. Therefore, further studies are needed to improve the quality of Hoffa fracture reduction under arthroscopy. [ 21] Matthewson et al [ 21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early [101]. Unable to load your collection due to an error, Unable to load your delegates due to an error. [53] In addition, partial nondisplaced Hoffa fractures are difficult to diagnose on anteroposterior and lateral views of the knee because the fracture lines often overlaps the side or lateral condyle, which can result in a missed diagnosis in as many as 30% of cases.[9,18]. Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Segmentation of the lateral femoral notch sign with MRI using a new 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.) 3 Although the examined patients were not professional athletes, some differences between these groups are worth mentioning: in the athletes, the medial rather than the lateral condyle was (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. your express consent. Gerdy's tubercle osteotomy for the, [69]. (A) Use of anterior cruciate ligament locator to assist drilling at the distal end of the femur. Cruciate fracture of the distal femur: the double. A patella that is stuck between the tibia and femur can be relocated naturally by flexing of the hip joint with the knee in 110 of flexion under local anesthesia. Careers. Busam ML, Provencher MT, Bach BR. Lateral femoral notch sign (knee) | Radiology Reference Article A lateral incision plus Gerdy tubercle osteotomy provides full exposure[68] especially in cases of coronal fracture of the lateral condyle. The site is secure. The authors have no funding and conflicts of interest to disclose. Orbital blow-out fracture | Radiology Reference Article | Radiopaedia.org We searched Medline, Embase, Cochrane Library, Google Scholar, China National Knowledge Infrastructure, and China Biology Medicine disc, using the terms Hoffa fracture and coronal fracture of femoral condyle.. Search for Similar Articles [10]. Open bicondylar, [23]. Mashoof et al[11] reported 7 cases of OCF in the weight-bearing area of LFC caused by patellar dislocation, of which 3 cases were treated with bioabsorbable screw fixation, but the follow-up results were not reported. J Orthop Trauma 1999;13:13840. 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. However, some patients had suture removal during the second arthroscopy because of suture irritation. The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request. Suture anchors are drilled into the posterolateral tibia to repair the meniscus to the meniscosynovial junction. Arastu MH, Kokke MC, Duffy PJ, et al. Fracture of the Femoral Condyles - Physio.co.uk Patellar dislocation with OCF in weight-bearing area of LFC is a rare injury in adolescents. Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa's fracture with patellar dislocation - a rare case. The distal femur is where the bone flares out like an upside-down funnel. During the operation, we found that 2.5*2. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. [74]. Wu P, WB, Kong LC, et al. [11,12] The bone marrow edema at the posterolateral aspect of the LFC suggest that the knee joint is highly flexed during patellar dislocation. A case report. Efficacy of multiple Acutrak hollow head compression screws in the, [68]. [75]. Li WH, Li Y, Wang MY. Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. Internal fixation with lag screws plus an antigliding plate for the, [88]. Tan et al[75] recommended an improved posterolateral approach starting from the space between the peroneal nerve and the biceps femoris. Allmann KH, Altehoefer C, Wildanger G, et al. [93]. (A) Through the hollow needle channel of the femoral intercondylar fossa, the folding corner of the PDS line are exposed to the knee joint cavity through the bone canal. For more information, please refer to our Privacy Policy. Technique for Treatment of Subchondral Compression Fracture of the Malunion: This happens when your broken bones don't line up correctly while they heal. Keyword Highlighting Kapoor C, Merh A, Shah M, et al. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Orthopedics, 2016, 39: e362e366. Surgical, [71]. Shah JN, Howard JS, Flanigan DC, et al. Fracture and dislocation compendium: Orthopaedic Trauma Association Committee for Coding and, [35]. This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). * Correspondence: Lijiang He, Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Hangzhou, Zhejiang 311121, China (e-mail: [emailprotected]). Osteochondral fractures of the lateral. [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. National Library of Medicine The most common way to fracture the femoral condyles is jumping from a large height. A rare case of unicondylar medial, [24]. For more information, please refer to our Privacy Policy. Tsai CH, Hsu CJ, Hung CH, et al. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. Hoffa nonunion, two cases treated with headless compression screws. Wolters Kluwer Health Orthop J Sports Med. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with Anchor absorbable suture bridge fixation is rigid enough, which can avoid second operation, save cost and good outcome could be expected, which is worth exploring; Of course, a large number of clinical data are needed for further comparative study. Primary traumatic patellar dislocation. 2014;22:238895. The Letenneur classification[31] divides fractures into 3 types (Fig. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. Arthroscopy-assisted fracture fixation. Bauer KL. Distal Femur (Thighbone) Fractures of the Knee - OrthoInfo - AAOS This site needs JavaScript to work properly. Biau DJ, Schranz PJ. [7]. The Authors. Liebergall M, Wilber JH, Mosheiff R, et al. [13] There are also many reports on OCF in non-weight-bearing area of LFC. [7]. [21] In contrast to unicondylar Hoffa fracture, a bicondylar Hoffa fracture is caused by a posterior and upward directed force and is not associated with knee valgus. [92]. At the same time, forces on the distal tibia are transferred to the tibial plateau, resulting in great shear stress between the femoral condyle and the tibial plateau. Radiography can reveal fracture lines. J Orthop Trauma 2002;16:17881. Impaction Fracture of the Medial Femoral Condyle 2020 The Authors. Arthroscopy 2012;28:13817. Vivek T, Saubhik Da, Sahil G, et al. Injury 2018;49:398403. The advantage of this approach is that it does not compromise future arthroplasty surgery; however, it does not allow visualization and treatment of any posterior comminution. Rev Chir Orthop Reparatrice Appar Mot. Vaishya R, Singh AP, Dar IT, et al. Arthroscopy. Report of 20 cases [in French]. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. Fracture of the Lateral Femoral Condyle | Journal of Orthopaedic You may search for similar articles that contain these same keywords or you may [3]. [54] However, popliteal and gastrocnemius muscle traction and foot or ankle movement can lead to fracture redisplacement,[5557] which can cause delayed fracture healing, nonunion, traumatic arthritis, knee dysfunction, and other complications. [50]. Arthroscopic. An unusual fracture of the lateral femoral condyle in a child. A patient, 15-year-old, female student. In these fractures, the popliteus tendon and the lateral head of the gastrocnemius muscle remain attached to the fragment. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. [10] Some of these patients may have a history of poliomyelitis that predisposes individuals to osteoporosis. Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. official website and that any information you provide is encrypted Sahu RL, Gupta P. Operative management of, [44]. As the knee is being extended and in full extension, it can be seen that femoral and tibial surfaces do not articulate with each other. [28]. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. Soraganvi PC, Narayan Gowda B, Rajagopalakrishnan R, et al. At present, open reduction is often used to treat osteochondral fractures. Agarwal S, Giannoudis PV, Smith RM. modify the keyword list to augment your search. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. At present, open reduction is often used to treat osteochondral fractures. Maenpaa H, Huhtala H, Lehto MU. This approach can also be used to treat comminuted fractures or complex Hoffa fractures.[18]. MRI of osteochondral defects of the lateral, [3]. Impaction Fracture of the Medial Femoral Condyle assessment of the anterior cruciate liga- ment with the anterior drawer and Lach- man tests was negative for laxity. You will need surgery to repair your bone, and recovery can take a year or longer. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. [27]. [72]. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Some error has occurred while processing your request. [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. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Knee Surg Sports Traumatol Arthrosc. 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. Am J Sports Med. YZ and YP contributed equally to this work. Plate fixation for Letenneur type I. Management of any globe injury generally takes precedence over fractures 1. In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. Data is temporarily unavailable. computed tomography scan and magnetic resonance (MRI) examination of knee joint further confirmed loose body within the knee joint, osteochondral defect in weight-bearing area of LFC and avulsion of medial patellofemoral ligament (Fig. Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. You may search for similar articles that contain these same keywords or you may Heuschen UA, Gohring U, Meeder PJ. Chin J Traumatol. Cheng S, Zaidi SF, Linnau KF. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. Knee Surg Sports Traumatol Arthrosc 2011;19:3209. Fixation with headless screws can reduce the degree of cartilage injury. [2,77] The heads of screws placed through the articular cartilage are countersunk to prevent damage to the cartilage. Arthroscopic-assisted fixation of. See this image and copyright information in PMC. Research Article: Systematic Review and Meta-Analysis. Oral application of Qiangguyin Keli and alendronate sodium vitamin D3 tablets in postoperative anti-osteoporosis. Osteochondral Fracture Lateral Femoral Condyle Treated with - Hindawi Humerus Fracture: Types, Symptoms & Treatment - Cleveland Clinic Subchondral insufficiency fracture of the knee: a non-traumatic injury [5] Viskontas et al[69] reported an extensile medial subvastus approach that allows better exposure of the surgical field and protects the blood supply of the bones comparing with the medial parapatellar approach. Femoral condyle insufficiency fractures: associated clinical and 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 . [58]. Injury 2011;42:14958. Injury 2005;36:8625. 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 . Lian X, Zeng YJ. The widely known Letenneur classification not only clarifies the relationships between the fracture line and ligaments and soft tissue, but also has significance for clinical treatment and prognosis. Complications of humerus fracture treatment. J Orthop Trauma 1994;8:1426. Operative. Goel A, Sabat D, Agrawal P. Arthroscopic-assisted fixation of, [13]. Am J Sports Med. [21]. [100,101] To avoid damaging the cartilage in these cases, it is important to reduce the patella early and restore the patellofemoral joint stability by repairing the damaged medial soft tissues. Reconstructive osteotomy for a malunited medial. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. [96,97] Thus, closed reduction is recommended when Hoffa fracture is accompanied by patella dislocation. [89]. Arthroscopy 2011;27:81724. Sasidharan B, Shetty S, Philip S, et al. Impaction Fracture of the Medial Femoral Condyle - JOSPT The term comminuted fracture refers to a bone that is broken in at least two places. 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. [92] Moreover, if soft tissue embedded within the fracture line prevents reduction, arthroscopy can distinguish the tissues and the degree of damage to assist restoration. Werner BC, Miller MD. [103]. 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. Knee Surg Sports Traumatol Arthrosc. Mashoof AA, Scholl MD, Lahav A, et al. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. [25]. [2] This fracture type was 1st described by Busch in 1869. [78] Previous studies showed the use of many screws to fix the Hoffa fracture, such as cancellous, cannulated, and headless used in a lag technique. [60]. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. [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. Distal pulses and sensation were intact. (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. Fractures of the distal femur typically occur in the axial and sagittal planes. your express consent. Xu Y, Li H, Yang HH, et al. Our hospital's institutional review board waived the need for ethical approval for this review paper. Arthroscopy-assisted, [55]. Difficulties involved in the Hoffa fractures [in German]. Two patients with osteochondral injury of the weight-bearing portion of the lateral. Westmoreland GL, McLaurin TM, Hutton WC. Highlight selected keywords in the article text. [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. Injury 1989;20:3714. The bone mass is missing at the fracture. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. In anterior cruciate ligament reconstruction, an anterior medial approach to the femoral tunnel allows restoration of the position of the tendon graft and increases rotation stability when an expanded bone tunnel is used for the graft. With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. [59]. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. [91]. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. sharing sensitive information, make sure youre on a federal [97]. Unauthorized use of these marks is strictly prohibited. Intra-operative fractures in primary total knee arthroplasty - a
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