Knee Surg Sports Traumatol Arthrosc. 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. J Knee Surg 2008;21:23540. Somford MP, van Ooij B, Schafroth MU, et al. Wang JY, Liu Y, Li Y, et al. A rare case of bicondylar. [ 21] Matthewson et al [ 21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early FOIA Clinical outcomes after absorbable suture fixation of patellar, [26]. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. The exposed fracture line is initially fixed with a k-wire and screws are placed perpendicular to the fracture surface. After the osteochondral mass was fixed in situ to the lateral condyle of the femur, 2 suture ends of the posterior suture anchor penetrate into the front bone tunnels respectively, and after penetrating from the LFC, they are knotted and fixed with 2 suture ends of medial suture anchor respectively (Fig. [64]. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Ozturk A, Ozkan Y, Ozdemir RM. [83]. 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. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. 2012;40:191623. Disclaimer. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. [94]. This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). [16]. 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. Int Orthop 2015;39:124550. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Lee SY, Niikura T, Iwakura T, et al. 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. [2]. modify the keyword list to augment your search. [36]. Tan Y, Li H, Zheng Q, et al. Surgically treated Hoffa Fractures with poor long-term functional results. Accessibility Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. [20]. Technique of reduction and fixation of unicondylar medial, [70]. patellar margin thus corresponding to impaction injuries. J Bone Joint Surg Am 2005;87:5649. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. Coronal fractures of the lateral femoral condyle. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. Pathology. Factors of patellar instability: an anatomic radiographic study. In general, there has been a trend toward . normal vital signs. [15]. your express consent. deep lateral sulcus sign - depression of lateral femoral condyle representing impaction fracture anterior tibial translocation sign Segond fracture arcuate fracture joint effusion CT Considered to have high specificity and sensitivity in detecting anterior cruciate ligament disruption 6. classification; diagnosis; Hoffa fracture; injury mechanism; treatment. [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. [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. Arthroscopic; Internal fixation; Osteochondral fracture; Suture anchor; TWINFIX Ti. 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). Plain radiograph Types I and III Hoffa fractures usually have a good prognosis because the soft tissue remains attached to the fragment, ensuring an adequate blood supply. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. Incarcerated patellar tendon in. osteochondral impaction fracture postsurgical (e.g. Monocondylar fractures of the femur: a review of 13 patients. Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. An unusual fracture of the lateral femoral condyle in a child. 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. [17]. You may be trying to access this site from a secured browser on the server. 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. Surgical, [71]. Werner BC, Miller MD. 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. White EA, Matcuk GR, Schein A, et al. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. [90]. [30]. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. Zhou S, Cai M, Huang K. Treatment of. [7]. Operative. [43]. Please enable scripts and reload this page. Min L, Tu CQ, Wang GL, et al. Epub 2020 Sep 18. Bone Joint J 2013;95-B:116571. may email you for journal alerts and information, but is committed Injury 2015;46:41921. Lateral Femoral Condyle (LFC) osteochondral fracture (HSL, Hill-Sachs-like Lesion) can be seen in 30 of knee flexion. (B) 1.5cm1.5cm free bone was found in the knee joint cavity, and the bone fracture was intact. [51]. A modified posterolateral approach for. Intra-articular dislocation of the patella with associated, [26]. ;Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Onay T, Glabi D, olak , et al. 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. Keyword Highlighting 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 . 2021 Jan 26;9(1):2325967120974649. doi: 10.1177/2325967120974649. Emerg Radiol 2015;22:3378. Femoral Condyle Fractures are a painful condition which can result from trauma injuries to the thigh bone and/or knee. following anterior cruciate ligament repair) Location The recognized sites of osteochondral defects are: femoral condyle (most common in the lateral aspect of the medial femoral condyle) humeral head talus capitellum of the humerus Staging The tears of the lateral meniscus and medial meniscus were detected during arthroscopy. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. Singh AP, Dhammi IK, Vaishya R, et al. Ostermann PA, Neumann K, Ekkernkamp A, et al. Westmoreland GL, McLaurin TM, Hutton WC. 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. Radiography can reveal fracture lines. Two cartilage masses can be seen during the operation. J Orthop Trauma 2006;20:2736. You may be trying to access this site from a secured browser on the server. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. 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. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). [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. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. The goals of treatment include restoration of function and esthetics. 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. [59]. This is the first report on a fracture of medial femoral condyle treated with this implant. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Osteochondral fracture of the lateral femoral condyle is a rare injury of the knee joint, which mostly occurs in adolescence 1.In adolescence, the cartilage-bone interface is the weakest transitional area in the knee joint, and there is no obvious boundary between calcified and uncalcified cartilage 2.The biomechanical strength of immature osteochondral junction was lower than . 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. Research Article: Systematic Review and Meta-Analysis. Chauhan A. Irreducible, incarcerated vertical dislocation of the patella into a. Gerdy's tubercle osteotomy for the, [69]. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Open bicondylar, [23]. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. 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. Posterior wall blowout in anterior cruciate ligament reconstruction: avoidance, recognition, and salvage. Arthroscopy. Bali K, Mootha AK, Krishnan V, et al. [104]. Am J Sports Med. Bookshelf Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. Injury 2018;49:398403. Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. 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. Plate fixation for Letenneur type I. Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. Wu P, WB, Kong LC, et al. Palmu S, Kallio PE, Donell ST, et al. 2). A case report. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. [47]. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. 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. Therefore, further studies are needed to improve the quality of Hoffa fracture reduction under arthroscopy. Unfallchirurg 2004;107:1521. [103]. The patient was evaluated by the physical therapist 2 days after his injury. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. Distal pulses and sensation were intact. Transverse Hoffa's or deep osteochondral fracture? Ann Chir 1978;32:2139. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. Impact fractures are due to track formation and propagation. A case of distal femur medial condyle Hoffa type II(C) fracture treated with headless screws. [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. Complications of humerus fracture treatment. 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. Knee Surg Sports Traumatol Arthrosc 2011;19:3209. [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. [55] Onay et al[79] performed a long-term follow-up study of Hoffa fracture patients treated with screws and observed that the screws provided sufficient biomechanical stability until the fractures were healed. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. sharing sensitive information, make sure youre on a federal Bethesda, MD 20894, Web Policies 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. Two patients with osteochondral injury of the weight-bearing portion of the lateral. Reconstructive osteotomy for a malunited medial. eCollection 2020 Jun. Radiographic features Usually, subchondral fractures present as linear or curvilinear structures often paralleling the subchondral bone plate, with or without areas of subchondral collapse 2. J Trauma 2000;48:15960. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature. The bone mass is missing at the fracture. Intra-articular dislocation of the patella. Vaishya R, Singh AP, Dar IT, et al. Lal H, Bansal P, Khare R, et al. Unicondylar femoral fractures: therapeutic strategy and long-term results. After hospitalization, the patients underwent computed tomography scan and magnetic resonance examination. Akan K, Akgun U, Poyanli O, et al. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. 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. Malays Orthop J 2017;11:204. The patient had an uneventful postoperative recovery. The white arrow indicate the defect area. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). [5]. This approach can also be used to treat comminuted fractures or complex Hoffa fractures.[18]. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. The funding sources have no role in study design, literature collection, review, data analysis, and manuscript preparation. http://creativecommons.org/licenses/by-nc-nd/4.0. 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. Epub 2022 Nov 15. Internal fixation with lag screws plus an antigliding plate for the, [88]. Long term results of unicondylar fractures of the femur. Suture anchors are drilled into the posterolateral tibia to repair the meniscus to the meniscosynovial junction. 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.. Previous article . Chin J Orthop Trauma 2009;9:8503. Soft tissues are retracted to . Some error has occurred while processing your request. J Orthop Surg Res 2012;7:21. your express consent. Arthrosc Tech 2015;4:e299303. The specific mechanism of a Hoffa fracture is not well understood. Miyamoto R, Fornari E, Tejwani NC. [97]. J Knee Surg. [33] Dua and Shamshery[34] proposed a classification method that supplements the AO classification with proper surgical planning to optimize outcomes. Please enable scripts and reload this page. Shah JN, Howard JS, Flanigan DC, et al. J Bone Joint Surg Br 1989;71:11820. [29]. [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. Acta Orthop Traumatol Turc. The work cannot be changed in any way or used commercially without permission from the journal. [100]. Osteochondral injuries of the knee in pediatric patients. In these cases, the associated patellar fracture results from a combination of forces: direct trauma causing the Hoffa fracture and possible indirect injuries from sudden contraction of the quadriceps muscle causing a vertical patellar fracture.[23].

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