In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. Am J Sports Med. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. eCollection 2020 Jun. Keywords: Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors. [5]. Somford MP, van Ooij B, Schafroth MU, et al. 2018;31:38291. Zhou S, Cai M, Huang K. Treatment of. Intra-articular dislocation of the patella. 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. Osteochondral fractures of the lateral. Soft tissues are retracted to . Bauer KL. Bicondylar. The authors have no conflicts of interest to disclose. Calmet J, Mellado JM, Garcia Forcada IL, et al. Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa's fracture with patellar dislocation - a rare case. Gao M, Tao J, Zhou Z, et al. Before 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). [93]. Please try after some time. 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. Osteochondral fracture (OCF) in weight-bearing area of lateral femoral condyle (LFC) is a rare combined injury caused by patellar dislocation. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Comminuted fractures are a type of broken bone. McDonough PW, Bernstein RM. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. Rosenberg NJ. your express consent. [53]. [4]. [90]. (LTC, Lateral Tibial Condyle.) The exposed fracture line is initially fixed with a k-wire and screws are placed perpendicular to the fracture surface. 1982;68:31725. A case report. A biomechanical study[5] shown that several smaller-diameter screws cause less damage to the joint cartilage than larger-diameter screws but that both have the same tensile force. sharing sensitive information, make sure youre on a federal Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. Arthroscopy 2011;27:81724. Distal pulses and sensation were intact. A review of 23 patients. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. [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. [9]. [66]. J Knee Surg. [3]. Med Sci Monit, 2012, 18: CS117CS120. [1]. 2020 The Authors. Knee Surg Sports Traumatol Arthrosc. [31]. Authors 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%. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. J Knee Surg 2008;21:23540. This site needs JavaScript to work properly. Methods All patients with post-injury bi-plane radiographs and MRI images after sustaining a tear to the anterior cruciate ligament were included. Cheng S, Zaidi SF, Linnau KF. Knee Surg Sports Traumatol Arthrosc. Am J Sports Med 2008;36:37994. J Orthop Trauma 2006;20:2736. [47]. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. 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%. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. Gerdy's tubercle osteotomy for the, [69]. [36]. 2020 Jun 15;9 (6):e823-e828. Refixation of large osteochondral fractures after patella dislocation shows better mid- to long-term outcome compared with debridement. Acta Orthop Traumatol Turc. In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. [21,22], In some patients, a Hoffa fracture is associated with a patellar fracture. Complications of humerus fracture treatment. Fixation with headless screws can reduce the degree of cartilage injury. J Bone Joint Surg Am 2006;88:22704. 2013;37:238594. [33] Dua and Shamshery[34] proposed a classification method that supplements the AO classification with proper surgical planning to optimize outcomes. Careers. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Arthroscopic management of a posterior femoral condyle (Hoffa) fracture: surgical technique. 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. The patient's treatment plan included 6 weeks of weight bearing as tolerated for the left lower extremity while wearing a knee brace that prevented the final 20 of knee extension, and a program of range-of-motion and progressive resistive exercises, with eventual emphasis on sport-specific activities. [56]. 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. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. Nonunion of coronal shear fracture of femoral condyle. Wu P, WB, Kong LC, et al. 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. This article discusses anatomic considerations, classification of condylar fractures, indications for surgery, treatment options, and complications. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. [ 21] Matthewson et al [ 21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early 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. 2018 Oct;21(5):308-310. doi: 10.1016/j.cjtee.2018.08.004. Injury 1989;20:3714. With a lower degree of knee flexion, the extensor mechanism is damaged below the patella (patellar tendon); at higher angles, the quadriceps tendon is torn. [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. The patellar height was in the normal range (Caton-Deschamp index 1.0). Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. J Bone Joint Surg Am 2008;90:46370. [85]. (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. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. [18]. Fractures of the distal femur typically occur in the axial and sagittal planes. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Shah JN, Howard JS, Flanigan DC, et al. Baker BJ, Escobedo EM, Nork SE, et al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. [10,38] Local manifestations of a Hoffa fracture include knee swelling, pain, skin color changes (with or without skin defects), limited knee mobility, and a positive floating patella test. Unfallchirurg 2004;107:1521. Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Viskontas DG, Nork SE, Barei DP, et al. Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. Choudhary RK, Tice JW. Medicine (Baltimore). 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. Hoffa fractures are caused by shear stress between the femoral condyle and tibial plateau. Incarcerated patellar tendon in. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Type II is a fracture horizontal to the base of the posterior condyle with fracture lines located posterior to the attachment point of the lateral collateral ligament. [22]. [16]. [52] This fact reminds us that a Hoffa fracture evaluation should be a routine part of the lower-limb and pelvis examination with or without injury. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. FIGURE 2. Lee et al[13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. The specific mechanism of a Hoffa fracture is not well understood. [11,12] The bone marrow edema at the posterolateral aspect of the LFC suggest that the knee joint is highly flexed during patellar dislocation. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. For local soft-tissue injuries, external fixation can be used, but this may delay the time to mobility restoration and affect therapeutic efficacy. Epub 2020 Sep 18. Ozturk A, Ozkan Y, Ozdemir RM. doi: 10.1097/MD.0000000000032104. Introduction. During the operation, 2 4.5mm anchor (Smith @ nephew TIWNFIX Ultra PK Suture Anchor) was inserted into the posterior edge and medial edge of the cartilage mass in the weight-bearing area, and then 2 non-absorbable sutures on each anchor were replaced by an absorbable suture (ETHICON VICRYL PLUS VCP359H), and finally the 2 ends of the absorbable suture were knotted to prevent sliding. 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. Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. official website and that any information you provide is encrypted 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. Knee flexion was limited less than 60 within 8 weeks after operation, partial weight-bearing was allowed at 8 weeks, followed by full weight bearing from 12 weeks after operation. [2]. (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. Please enable scripts and reload this page. Callewier A, Monsaert A, Lamraski G. Lateral. 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. The incidence ratio in male and female patients is in the range . Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. J Orthop Trauma 1994;8:1426. 2022 Dec 16;101(50):e32104. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. Arastu MH, Kokke MC, Duffy PJ, et al. Hoffa's fractures. A rare case of unicondylar medial, [24]. Moreover, the placement of a posterior antiglide plate with screws strips more soft tissue, especially the insertion of the gastrocnemius heads, and may destroy the blood supply to the fragments. Manfredini M, Gildone A, Ferrante R, et al. [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Emerg Radiol 2015;22:3378. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. -, Biau DJ, Schranz PJ. 2). Soni A, Sen RK, Saini UC, et al. For Letenneur II and some Letenneur III fractures close to the posterior cortex of the femoral condyle, cannulated lag screw fixation is commonly used. [1] A Hoffa fracture, a rare fracture confined to the coronal plane of either femoral condyle, accounts for 8.7% to 13% of distal femoral fractures. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. Knee Surg Sports Traumatol Arthrosc 2011;19:3209. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. The bone mass is missing at the fracture. Data is temporarily unavailable. [39]. Arthroscopy-assisted, [55]. Li ZX, Song HH, Wang Q, et al. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. Published by Wolters Kluwer Health, Inc. [18]. This method is beneficial for reducing small and rotating fragments. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. Headless compression screws are self-compressing and can be positioned beneath the outer cortex resulting in significantly greater axial compression, a higher load limit, and increased fracture stability. [76]. [65]. [98]. Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. National Library of Medicine Lewis SL, Pozo JL, Muirhead-Allwood WF. Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. J Trauma 2000;48:15960. Seeley MA, Knesek M, Vanderhave KL. 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. J Surg Case Rep 2012;2012:10. 1). Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. Sanders TG, Paruchuri NB, Zlatkin MB. Clinical outcomes after absorbable suture fixation of patellar, [26]. The anatomical plate for distal medial condyle fracture of femur should be developed as soon as possible. J Clin Orthop Trauma 2014;5:3841. [94]. The treatment options for OCF of LFC include: loose body removal, microfracture, open reduction and internal fixation, cartilage transplantation, autologous or allogeneic osteochondral transplantation, etc. Treatment and prognosis. The patient had no previous history of patella dislocation and pain around the knee. Intra-articular corrective osteotomy for malunited. Epub 2018 Oct 4. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. Plain radiograph Intra-articular dislocation of the patella with associated, [26]. [9] The pain due to these combined injuries often exceeds that caused by the Hoffa fracture, which can lead physicians to miss the latter. 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. Caton J, Deschamps G, Chambat P, et al. Arthroscopic; Internal fixation; Osteochondral fracture; Suture anchor; TWINFIX Ti. 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 . A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. In these cases, avulsion of the anterior cruciate ligament along with a large chunk of bone at its insertion[17] can lead to a Hoffa fracture. Oper Dent 2007;32:25160. Acta Biomater, 2019, 93:222238. Lateral-view radiograph of the left knee demonstrating an abnormally deep depression of the medial condylopatellar sulcus (arrow). The Authors. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. [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. J Bone Joint Surg Br 1989;71:11820. In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. Radiography can reveal fracture lines. Smith EJ, Crichlow TP, Roberts PH. [17]. 2003;19:71721. The bone contusions on the lateral femoral condyle, lateral aspect of the tibial plateau, medial femoral condyle, and medial aspect of the tibial plateau were documented. Letenneur J, Labour PE, Rogez JM, et al. (C) The free edge of the anterior foot of the meniscus was rough (degree I). 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. Zhao LL, Tong PJ, Xiao LW. Ercin E, Bilgili MG, Basaran SH, et al. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. findings identifies vascular segments with diminished flow vascular injury The Letenneur classification[31] divides fractures into 3 types (Fig. 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). Comminuted fractures are caused by severe traumas like car accidents. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Injury 2015;46:41921. [7]. Zeebregts CJ, Zimmerman KW, ten Duis HJ. [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. [79]. Busam ML, Provencher MT, Bach BR. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. Please enable scripts and reload this page. This system allows the classification of comminuted femoral condyle fractures. This approach can also be used to treat comminuted fractures or complex Hoffa fractures.[18]. Skeletal Radiol 2015;44:3743. The distal femur is the area of the leg just above the knee joint. [20]. 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. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. osteochondral impaction fracture postsurgical (e.g. Wolters Kluwer Health 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. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. Frangakis EK.
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