Nonunion of coronal shear fracture of femoral condyle. [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. Liebergall M, Wilber JH, Mosheiff R, et al. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. Three types of fracture are defined based on the coronal fracture line (Fig. Disclaimer. A comparison of the clinical effect of two fixation methods on Hoffa fractures. For simple lateral condylar Hoffa fractures, a patellar anterolateral approach is most commonly used. (A) MRI examination of the right knee joint: the bone continuity at the edge of the lateral condyle of the right femur was poor, the patchy high signal intensity was seen in the bone marrow cavity of the lateral condyle of the femur, and the local cartilage became thinner in the corresponding area. Jabalameli M, Bagherifard A, Hadi H, 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. J Orthop Trauma 2006;20:2736. Knee Surg Sports Traumatol Arthrosc. [23]. Braune C, Rehart S, Kerschbaumer F, Jger A. Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout: a cadaveric study. [25] A cannulated screw combined with a plate is recommended in these cases. 2001;17:5425. Distal Femur Fractures - Trauma - Orthobullets 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. Comminuted Fracture: Symptoms, Causes & Treatment - Cleveland Clinic doi: 10.1016/j.arthro.2006.11.029. Epub 2018 Oct 4. A rare case of unicondylar medial, [24]. . Wolters Kluwer Health [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. Among the various types of Hoffa fractures, the Letenneur II is unique because the fragments are small and difficult to fix, and poor blood supply to the fragments impairs its healing. An unusual fracture of the lateral femoral condyle in a child. 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. In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. FOIA Published by Wolters Kluwer Health, Inc. You may search for similar articles that contain these same keywords or you may [28]. Wu P, WB, Kong LC, et al. 1). 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. Monocondylar fractures of the femur: a review of 13 patients. Fracture of the Femoral Condyles - Physio.co.uk Nandy K, Raman R, Vijay RK, et al. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. 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. 1). Cartilage. Frangakis EK. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. Li WH, Li Y, Wang MY. J Pediatr Orthop B, 2013, 22: 344349. You may search for similar articles that contain these same keywords or you may Li ZX, Song HH, Wang Q, et al. [25]. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. Keyword Highlighting Factors of patellar instability: an anatomic radiographic study. Gelber PE, Erquicia J, Abat F, et al. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. Therefore, further studies are needed to improve the quality of Hoffa fracture reduction under arthroscopy. Seeley MA, Knesek M, Vanderhave KL. Med Sci Monit, 2012, 18: CS117CS120. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. Please try again soon. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. Skeletal Radiol 2015;44:3743. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. The patient had an uneventful postoperative recovery. 2003;19:71721. Highlight selected keywords in the article text. Operative, [46]. Lateral femoral notch sign (knee) | Radiology Reference Article [80] From a biomechanical point of view, when the load is in the vertical direction, posteroanterior screw placement has a lower risk of shifting than anteroposterior placement. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. [53,91] However, some Hoffa fractures combined with a tear of the posterolateral horn of the lateral meniscus are identified intraoperatively, and tear of the lateral meniscus can be repaired with suture anchors. [18]. Lateral-view radiograph of the left knee demonstrating an abnormally deep depression of the medial condylopatellar sulcus (arrow). Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. Fractures of the distal femur typically occur in the axial and sagittal planes. Get new journal Tables of Contents sent right to your email inbox, December 16, 2022 - Volume 101 - Issue 50, Creative Commons Attribution License 4.0 (CCBY), Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report, Articles in Google Scholar by Liang Wu, MM, Other articles in this journal by Liang Wu, MM, Benign optic nerve gliomas in an adult: A case report, Analysis of the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture: A review, A bibliometric and emerging trend analysis on stress granules from 2011 to 2020: A systematic review and bibliometrics analysis, Inhaled opioids for cancer pain relief: A narrative review, Primary seminoma of prostate in a patient with Klinefelter syndrome: A case report, Privacy Policy (Updated December 15, 2022). Injury 2005;36:8625. Internal fixation with lag screws plus an antigliding plate for the, [88]. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with [42] Compared with anteroposterior and lateral films, oblique radiographic views can show minimally displaced fractures better[14] and can, therefore, be used as a routine examination method for a Hoffa fracture. We replaced the anchor suture with (ETHICON VICRYL PLUS VCP 359H) suture during the operation, which is an attempt based on the research of Li,[25] in order to avoid the second operation. [2]. [22]. Recurrence after patellar dislocation. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. Following Letenneur classification of coronal fractures of the femoral condyle in the 1970s and the publication of the second version of the Manual of Internal Fixation, the Hoffa fracture has become more widely recognized by orthopedists. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. Khle J, Angele P, Balcarek P, et al. Some error has occurred while processing your request. [72]. [38]. Analysis of functional outcome of Hoffa fractures: a retrospective review of 32 patients. Would you like email updates of new search results? The CT classification[32] uses the anatomic femoral axis and a line parallel to the posterior cortex of the femoral condyle to divide the femoral condyle into a, b, and c regions. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [15]. Comminuted fractures are a type of broken bone. [6]. Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. 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. [58]. Previous article . The patient was evaluated by the physical therapist 2 days after his injury. Ostermann PA, Neumann K, Ekkernkamp A, et al. [105]. According to the internal fixation principle, the antiglide plate should be fixed in the posterior position. Oper Dent 2007;32:25160. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. A meta-analysis by Khle et al[6] show that there is no unified treatment for osteochondral fractures (OCF) of knee joint at present, and the overall failure rate is 17%. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. Search for Similar Articles During the operation, we found that 2.5*2. Z Orthop Ihre Grenzgeb. Oral application of Qiangguyin Keli and alendronate sodium vitamin D3 tablets in postoperative anti-osteoporosis. modify the keyword list to augment your search. [93]. Introduction. Heuschen UA, Gohring U, Meeder PJ. Maenpaa H, Huhtala H, Lehto MU. [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. [57]. Medial and lateral buttressing may be required if either fracture extends proximally in the same plane. Please enable scripts and reload this page. [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. You may be trying to access this site from a secured browser on the server. eCollection 2020 Jun. [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. -, Morris John K, Weber Alexander E, Morris Mark S. Adolescent femoral chondral fragment fixation with polyLlactic acid chondral darts. Gao et al[70] reported a medial to medial-posterior distal femur approach in which the fragments were exposed through the interval space between the gracilis muscle and medial head of the gastrocnemius and the medial collateral ligament can be clearly exposed and protected. The typical MRI findings after transient lateral dislocation of the patella have been well described and include a bone contusion pattern involving the inferomedial pole of the patella and the anterolateral aspect of the nonarticular portion of the lateral femoral condyle. chauffeur fracture: intraarticular fracture involving radial styloid; Another type of distal radius fracture is the Lister's tubercle fracture. During complete anterior cruciate ligament (ACL) tears in pivoting mechanisms, the area of the lateral femoral condyle (LFC) localized just above the anterior third of the lateral meniscus (LM) impacts the posterior border of the lateral tibial plateau (LTP), which may result in a subchondral compression fracture. may email you for journal alerts and information, but is committed This is the first case to apply the suture anchor system to the reduction and fixation of fracture. [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. 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. [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. After 1 year follow-up, good functional and radiographic outcome were obtained. Dave LY, Nyland J, Caborn DN. [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. Potini VC, Gehrmann RM. McCarthy JJ, Parker RD. Subchondral impaction fractures of the non-weight-bearing - PubMed Injury 2018;49:398403. 5 and 6), and the lysholm score was 95 points, which was very good. Ji G, Wang S, Wang X, et al. Arthroscopy. For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. [18]. Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro. Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. Rue JP, Busam ML, Detterline AJ, et al. [7]. Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. Hoffa fragment associated with a femoral shaft fracture. Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. This method is also recommended for patients with osteoporosis, metaphyseal extension, or comminuted Hoffa fractures. [6]. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Impaction Fracture of the Medial Femoral Condyle - JOSPT Based on plate position, screws can be combined with a lateral antigliding plate[84] or a posterior antigliding plate.[55,87]. Osteochondral Fracture Lateral Femoral Condyle Treated with - Hindawi Distal Femur (Thighbone) Fractures of the Knee - OrthoInfo - AAOS Agarwal S, Giannoudis PV, Smith RM. Starr AJ, Jones AL, Reinert CM. Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa's fracture with patellar dislocation - a rare case. Screw insertion direction differs among operative approaches. Difficulties involved in the Hoffa fractures [in German]. Wu, Liang MMa; Liu, Chao BMb; Jiang, Bing BMc; He, Lijiang MMd,*, a Department of Orthopedic Surgery, First Peoples Hospital of Linpin District, Hangzhou, Zhejiang, China, b Department of General Surgery, Medicine Faculty of Universitas Prima Indonesia, North Sumatra, Indonesia, c Department of General Surgery, Daocheng Country Peoples Hospital, Sichuan, China. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. CT examination 6months after operation: one screw internal fixation, regular external condyle cortex, good alignment at the end of fracture, callus growth and unclear fracture line could be seen in the right lateral femoral condyle. In general, there has been a trend toward . government site. A 15-year-old female student accidentally sprained her right knee while participating in sports activities. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. View Large Image Download Hi-res image Download (PPT) By definition, secondary osteonecrosis of the knee occurs secondary to an insult. [10]. 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 . Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fractures--a prospective review of 18 patients. Osteochondral fractures of the lateral, [11]. Busam ML, Provencher MT, Bach BR. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Min L, Tu CQ, Wang GL, et al. J Bone Joint Surg Am 2008;90:46370. [98]. 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. Transverse Hoffas or deep. [43] If radiographic examination is not diagnostic but a Hoffa fracture is suspected, a CT scan, which is the gold standard for diagnosis of a Hoffa fracture, should be performed. In addition, the lateral antiglide plate can provide stable support, and in combination with autologous bone grafting can promote fracture healing,[38,55,89] which is especially useful for treating old Hoffa fractures. Arthroscopy. Acta Orthop Belg 2001;67:1328. Surgically treated Hoffa Fractures with poor long-term functional results. Preliminary X-ray examination showed osteochondral defects of LFC and loose body in knee joint (Fig. Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. Technique for Treatment of Subchondral Compression Fracture of the Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. Introduction. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. [Resorbable pin refixation of an osteochondral fracture of the lateral femoral condyle due to traumatic patellar dislocation: case management, follow-up and strategy in adolescents]. 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. [Patella infera. J Bone Joint Surg Br 1989;71:11820. Shetty GM, Wang JH, Kim SK, et al. Unauthorized use of these marks is strictly prohibited. Subchondral insufficiency fracture of the knee is not thought to be caused by bone death but instead by osteoporosis and insufficiency fractures, with histopathologically proven origins in weakened trabeculae and applied microtraumatic forces 6,13. Ercin E, Baca E, Kural C. Arthroscopic. Surgical versus nonsurgical treatments of acute primary patellar dislocation with special emphasis on the MPFL injury patterns. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. (C) The free edge of the anterior foot of the meniscus was rough (degree I). Posterior wall blowout in anterior cruciate ligament reconstruction: avoidance, recognition, and salvage. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures.

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