Femoral Condyle Fractures are a painful condition which can result from trauma injuries to the thigh bone and/or knee. Bioactive factors for cartilage repair and regeneration: improving delivery, retention, and activity. Bone Joint J 2013;95-B:116571. A lateral incision plus Gerdy tubercle osteotomy provides full exposure[68] especially in cases of coronal fracture of the lateral condyle. Wang JY, Liu Y, Li Y, et al. [33] Dua and Shamshery[34] proposed a classification method that supplements the AO classification with proper surgical planning to optimize outcomes. The injury to MCL was also observed with MRI. Sahu RL, Gupta P. Operative management of, [44]. Data is temporarily unavailable. HHS Vulnerability Disclosure, Help Intra-articular corrective osteotomy for malunited. Acta Orthop Traumatol Turc. Our hospital's institutional review board waived the need for ethical approval for this review paper. 1994;2:1926. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. Tong W, Yang J, Xu PL, et al. Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. The incidence ratio in male and female patients is in the range . your express consent. Chauhan A. Irreducible, incarcerated vertical dislocation of the patella into a. Baker BJ, Escobedo EM, Nork SE, et al. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. Choudhary RK, Tice JW. [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 insertion direction differs among operative approaches. modify the keyword list to augment your search. In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. This site needs JavaScript to work properly. Acta Orthop Belg 2001;67:1328. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. [66]. Tan et al[75] recommended an improved posterolateral approach starting from the space between the peroneal nerve and the biceps femoris. Bali K, Mootha AK, Krishnan V, et al. McCarthy JJ, Parker RD. However, some patients had suture removal during the second arthroscopy because of suture irritation. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. Injury 2005;36:8625. Search for Similar Articles [99]. Calmet J, Mellado JM, Garcia Forcada IL, et al. [64]. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. The distal femur is where the bone flares out like an upside-down funnel. [97]. 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. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. 3). Khle J, Angele P, Balcarek P, et al. Shah et al[19] systematically reviewed the recurrent patellar dislocation and found that the complication rate of patellar medial collateral ligament reconstruction was as high as 26.1%. (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. Authors The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. [84]. Soraganvi PC, Narayan Gowda B, Rajagopalakrishnan R, et al. [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. Med Sci Monit, 2012, 18: CS117CS120. [30]. Monocondylar fractures of the femur: a review of 13 patients. 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. [58]. Dhillon MS, Mootha AK, Bali K, et al. absorbable internal fixation; dislocation of patella; femoral condyle; osteochondral fracture. (A) One 1.5mm Kirschner wire temporarily fixed the fracture block of the lateral condyle of the femur. In some cases, the Letenneur II fragment is small but essential for the knee join when flexed at 90 because it ensures the articular surface integrity. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. Injury 2015;46:41921. The specific mechanism of a Hoffa fracture is not well understood. government site. If fractures are present they are usually associated with orbital rim or other significant craniofacial injuries. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. [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. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Moreover, even if the medial patellar retinaculum is strengthened, the patient still has symptoms such as anterior knee pain. Soft tissues are retracted to . 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. Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. Ul Haq R, Modi P, Dhammi I, et al. (LTC, Lateral Tibial Condyle.) 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. Injury, 2005, 36: 862865. 2). [50]. Careers. Hoffa fractures are caused by shear stress between the femoral condyle and tibial plateau. Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. Oper Dent 2007;32:25160. Osteochondral injuries of the knee in pediatric patients. findings identifies vascular segments with diminished flow vascular injury When the patient was sent to the emergency room, the right knee swelled obviously, tenderness over the medial border of the patella, the apprehension test was positive, lateral stress test was negative, and the knee range of motion:F/E 90/0. Would you like email updates of new search results? After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. chauffeur fracture: intraarticular fracture involving radial styloid; Another type of distal radius fracture is the Lister's tubercle fracture. With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. 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. For local soft-tissue injuries, external fixation can be used, but this may delay the time to mobility restoration and affect therapeutic efficacy. Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. This system allows the classification of comminuted femoral condyle fractures. J Pediatr Orthop B, 2013, 22: 344349. Springerplus 2016;5:1164. 2013;185:61120. -, Morris John K, Weber Alexander E, Morris Mark S. Adolescent femoral chondral fragment fixation with polyLlactic acid chondral darts. The tears of the lateral meniscus and medial meniscus were detected during arthroscopy. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. 2013;37:238594. Operative. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. [4]. [10]. Two cartilage masses can be seen during the operation. An attempt to treat Hoffa fractures under arthroscopy: A case report. Search for Similar Articles [7] The development of trochlear sulcus of femur was classified as type A according to Dejour et al,[8] and the TT-TG[9] was 15mm. doi: 10.1016/j.arthro.2006.11.029. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). [102]. 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. Singh AP, Dhammi IK, Vaishya R, et al. 2007;41 Suppl 2:105-12. Some patellar dislocations are difficult to treat with closed reduction because the patella is attached to the intercondylar fossa by the quadriceps femoris[98] and rotational or vertical displacement is present. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. impacted and stress fractures. Your message has been successfully sent to your colleague. Li WH, Li Y, Wang MY. J Knee Surg 2013;26(Suppl 1):S8993. Incarcerated patellar tendon in. Gesslein M, Merkl C, Bail HJ, et al. [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. Hoffa fragment associated with a femoral shaft fracture. [65]. [19]. Transverse Hoffa's or deep osteochondral fracture? Zhou S, Cai M, Huang K. Treatment of. official website and that any information you provide is encrypted [5]. Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. National Library of Medicine patellar margin thus corresponding to impaction injuries. Please try again soon. 1982;68:31725. 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. [17]. [8]. 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. [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. After arthroscopic confirmation of Lateral Femoral Condyle (LFC) ostechondral fracture (HSL, Hill-Sachs-like Lesion) the anterolateral portal is enlarged to 2-3 cm. [6]. Keywords: 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 Hoffa's or deep osteochondral fracture? Treatment options include loose body removal, microfracture, multiple internal fixation and so on. 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. Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fractures--a prospective review of 18 patients. Lal H, Bansal P, Khare R, et al. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. Non-union coronal fracture femoral condyle, sandwich technique: a case report. Orthopedics, 2016, 39: e362e366. Allmann KH, Altehoefer C, Wildanger G, et al. -. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. An official website of the United States government. J Bone Joint Surg Am 2008;90:46370. Internal fixation with lag screws plus an antigliding plate for the, [88]. [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. [25] Loss of bone matrix results in brittle, weaker bones that break rather than bend with external force. 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.) During the operation, we found that 2.5*2. 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%. [5-9] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Lateral radiographs of the affected knee were inspected for a . (B) AIMER was located at the outlet of the medial bone canal of the lateral condyle of the femur. 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. You may search for similar articles that contain these same keywords or you may Complications of anterior cruciate ligament reconstruction with bone-patellar tendon-bone constructs: care and prevention. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. Chin J Orthop Trauma 2009;9:8503. Cruciate fracture of the distal femur: the double. [80]. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by-nc-nd/4.0, Hoffa fracture of the femoral condyle: Injury mechanism, classification, diagnosis, and treatment, Articles in Google Scholar by Yabin Zhou, MD, Other articles in this journal by Yabin Zhou, MD, Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A meta-analysis of randomized controlled trails, Hoffa fracture combined with rotational dislocation of the knee joint: A novel case report, PET/CT-negative malignant spine tumor with pathologic fracture: A case report of malignant solitary bone plasmacytoma, Prognostic factors to survival of patients with chondroblastic osteosarcoma, Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis, Privacy Policy (Updated December 15, 2022). A fracture is a broken bone. J Clin Orthop Trauma 2015;6:4650. 2018 Oct;21(5):308-310. doi: 10.1016/j.cjtee.2018.08.004. The patient felt pain in his right knee and limited movement. Disclaimer. eCollection 2020 Jun. Federlin M, Krifka S, Herpich M, et al. 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. For more information, please refer to our Privacy Policy. [28]. ;Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. 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. Plain radiograph Reconstructive osteotomy for a malunited medial. 2021. Sharath RK, Gadi D, Grover A, et al. [90]. [20]. Epub 2020 Sep 18. For tibial fractures, the use of bone plates or intramedullary nails is recommended if the condition of the local soft tissue is suitable. [21]. [31]. You may be trying to access this site from a secured browser on the server. Rev Chir Orthop Reparatrice Appar Mot. Ji G, Wang S, Wang X, et al. classification; diagnosis; Hoffa fracture; injury mechanism; treatment. 2021;13(1_suppl):966S73S. J Bone Joint Surg Am 2005;87:5649. We used the key words Hoffa fracture and coronal fracture of femoral condyle for the knowledge. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors. 5 and 6), and the lysholm score was 95 points, which was very good. doi: 10.1097/MD.0000000000032104. Highlight selected keywords in the article text. [72]. [85]. Type 2 fractures require a . MRI of osteochondral defects of the lateral, [3]. Management of any globe injury generally takes precedence over fractures 1. Cartilage. [47]. Sasidharan B, Shetty S, Philip S, et al. 1986;14:11720. [79]. 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. Familiarity with the characteristics of Hoffa fracture on various imaging modalities and an understanding of the mechanism and likelihood of combined injuries contribute to the timely and accurate diagnosis of Hoffa fracture and avoiding misdiagnosis. The anatomical plate for distal medial condyle fracture of femur should be developed as soon as possible.