For more information, please refer to our Privacy Policy. Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. (B) 1.5cm1.5cm free bone was found in the knee joint cavity, and the bone fracture was intact. 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. Friederichs MG, Greis PE, Burks RT. Kapoor C, Merh A, Shah M, et al. Internal fixation with headless compression screws and back buttress plate for. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. Osteochondral injury after acute patellar dislocation in children and adolescents. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Intra-articular corrective osteotomy for malunited. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa's fracture with patellar dislocation - a rare case. [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. Many author think these injuries are caused by the impact between the patella and femoral condyle with a knee flexed over 90. Wagih AM. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. 2021 Jan 26;9(1):2325967120974649. doi: 10.1177/2325967120974649. [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. [53]. A hip fracture is a break that occurs in the upper part of the femur (thigh bone). At present, open reduction is often used to treat osteochondral fractures. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. Background The goal of this present study was to precisely determine the dimension and location of the impaction fracture on the lateral femoral condyle in patients with an ACL rupture. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. Meta plate and cannulated screw fixation for, [86]. PMC 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. Hoffa's fractures. Radiographic appearance Highlight selected keywords in the article text. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. [95]. Subchondral insufficiency fracture of the knee - Radiopaedia Injury 2018;49:398403. Busam ML, Provencher MT, Bach BR. The .gov means its official. Surgically treated Hoffa Fractures with poor long-term functional results. See this image and copyright information in PMC. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. Frangakis EK. Sharath RK, Gadi D, Grover A, et al. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. Please enable scripts and reload this page. [Treatment of extensive chondral defects of the patella after patellar dislocation]. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. Soraganvi PC, Narayan Gowda B, Rajagopalakrishnan R, et al. [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. [103]. Acta Chir Orthop Traumatol Cech. Technique for Treatment of Subchondral Compression Fracture of the Report of 20 cases [in French]. Life (Basel). Starr AJ, Jones AL, Reinert CM. Skeletal Radiol 2015;44:3743. Conjoint bicondylar, [22]. J Bone Joint Surg Am 2006;88:22704. Arthroscopy 2011;27:81724. [21] Matthewson et al[21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early internal fixation and external fixation to avoid early weight bearing, and achieved good results. Research Article: Systematic Review and Meta-Analysis. 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. J Clin Orthop Trauma 2015;6:4650. 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. Subchondral insufficiency fracture of the knee: a non-traumatic injury [11,12] The bone marrow edema at the posterolateral aspect of the LFC suggest that the knee joint is highly flexed during patellar dislocation. (PDF) Technique for Treatment of Subchondral Compression Fracture of [6]. Type 2 fractures require a . This system allows the classification of comminuted femoral condyle fractures. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. The patient had no previous history of patella dislocation and pain around the knee. Complications of humerus fracture treatment. modify the keyword list to augment your search. Previous article . Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. Soft tissues are retracted to . Osteochondral injuries of the knee in pediatric patients. For simple lateral condylar Hoffa fractures, a patellar anterolateral approach is most commonly used. Dhillon MS, Mootha AK, Bali K, et al. Plate fixation for Letenneur type I. chauffeur fracture: intraarticular fracture involving radial styloid; Another type of distal radius fracture is the Lister's tubercle fracture. [101]. White EA, Matcuk GR, Schein A, et al. Wolters Kluwer Health [80]. [99]. Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. 2017;30:37884. [17]. Malunion: This happens when your broken bones don't line up correctly while they heal. View Large Image Download Hi-res image Download (PPT) Matthewson MH, Dandy DJ. [77]. Wolters Kluwer Health In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. Chin J Traumatol. to maintaining your privacy and will not share your personal information without Vaishya R, Singh AP, Dar IT, et al. 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. 1986;14:11720. and transmitted securely. The term comminuted fracture refers to a bone that is broken in at least two places. The functional and radiographic outcome were satisfactory at 18 months after operation. J Knee Surg. Heuschen UA, Gohring U, Meeder PJ. Egol KA, Broder K, Fisher N, et al. Acta Orthop Traumatol Turc 2014;48:3837. Fractures of the distal femur typically occur in the axial and sagittal planes. [51]. A patient, 15-year-old, female student. [10] Some of these patients may have a history of poliomyelitis that predisposes individuals to osteoporosis. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. Lateral femoral condyle osteochondral fracture combined to patellar 2). Comminuted Fracture: Symptoms, Causes & Treatment - Cleveland Clinic Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. National Library of Medicine 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 patient was referred to an or- thopaedic surgeon, who recommended conservative management. Acta Orthop Traumatol Turc. Sagittal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. Please try again soon. Epub 2020 Sep 18. Med Sci Monit, 2012, 18: CS117CS120. [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. official website and that any information you provide is encrypted Arthroscopy. Braune C, Rehart S, Kerschbaumer F, Jger A. Two cartilage masses can be seen during the operation. Highlight selected keywords in the article text. The white arrow indicate the defect area. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. Femoral Condyle Fractures - Symptoms, Causes, Treatment | Physio [79]. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. Epub 2007 Mar 23. [1]. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. Anterior cruciate ligament tear | Radiology Reference Article Difficulties involved in the Hoffa fractures [in German]. The site is secure. [37]. [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. modify the keyword list to augment your search. The authors have no funding and conflicts of interest to disclose. Arastu MH, Kokke MC, Duffy PJ, et al. [21]. [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. 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. The distal femur is where the bone flares out like an upside-down funnel. may email you for journal alerts and information, but is committed For local soft-tissue injuries, external fixation can be used, but this may delay the time to mobility restoration and affect therapeutic efficacy. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. Federal government websites often end in .gov or .mil. Segmentation of the lateral femoral notch sign with MRI using a new 1). Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). Chin J Traumatol 2011;14:1436. -, Morris John K, Weber Alexander E, Morris Mark S. Adolescent femoral chondral fragment fixation with polyLlactic acid chondral darts. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. An unusual fracture of the lateral femoral condyle in a child. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. [15]. You may search for similar articles that contain these same keywords or you may [50]. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. Distal femur fractures most often occur either in older people whose bones . Radiography can reveal fracture lines. [58]. Femoral Condyle Fractures are a painful condition which can result from trauma injuries to the thigh bone and/or knee. normal vital signs. Surgical treatment of femoral medial condyle fracture with lag screws classification; diagnosis; Hoffa fracture; injury mechanism; treatment. The patient was evaluated by the physical therapist 2 days after his injury. [Patella infera. -, Biau DJ, Schranz PJ. 1982;68:31725. [66]. Atesok K, Doral MN, Whipple T, et al. Lewis SL, Pozo JL, Muirhead-Allwood WF. 1). Nonunion of a. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. [9]. 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%. (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. Nakagawa S, Arai Y, Inoue H, et al. [82]. At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: Reduce Pain Restore Movement Optimise Recovery What are Femoral Condyle Fractures? The authors have no conflicts of interest to disclose. [85]. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. You will need surgery to repair your bone, and recovery can take a year or longer. 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. Baker BJ, Escobedo EM, Nork SE, et al. This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). -, Patel JM, Saleh KS, Burdick JA, Mauck RL. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. Nonunion of coronal shear fracture of femoral condyle. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Subchondral Impaction Fractures of the Medial Femoral Condyle in - LWW Pa a et al[17] reported that 10 patients with patellar osteochondral mass less than 2.7mm2 caused by patellar dislocation still achieved good function only by taking out the loose body, and no patellar dislocation was found. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [72]. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. Wu P, WB, Kong LC, et al. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. J Bone Joint Surg Br 1989;71:11820. (A) One 1.5mm Kirschner wire temporarily fixed the fracture block of the lateral condyle of the femur. Before J Orthop Trauma 2002;16:17881. Low-energy trauma can cause Hoffa fractures in people with skeletal immaturity[24] as well as in those with low bone mass, such as patients with osteoporosis. 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. Moreover, even if the medial patellar retinaculum is strengthened, the patient still has symptoms such as anterior knee pain. J Bone Joint Surg Am 2008;90:46370. Irreducible, incarcerated vertical dislocation of patella into a. [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. Our hospital's institutional review board waived the need for ethical approval for this review paper. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. Please enable scripts and reload this page. Monocondylar fractures of the femur: a review of 13 patients. Redislocation in 37/75 patients followed for 6-24 years. Liebergall M, Wilber JH, Mosheiff R, et al. Manfredini M, Gildone A, Ferrante R, et al. [93]. [10]. 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. [10] Werner and Miller [11] reported that iatrogenic injury is a cause of Hoffa fracture . Intertrochanteric Fractures of the Femur | SpringerLink 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. doi: 10.1016/j.eats.2020.02.016. The goals of treatment include restoration of function and esthetics. 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. The https:// ensures that you are connecting to the Operative. Reconstructive osteotomy for a malunited medial. Shetty GM, Wang JH, Kim SK, et al. Subchondral fracture | Radiology Reference Article | Radiopaedia.org Primary traumatic patellar dislocation. [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. [2] This fracture type was 1st described by Busch in 1869. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. [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. 2003;19:71721. 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. Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. 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. Allmann KH, Altehoefer C, Wildanger G, et al. We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteen-year-old male with a positive history of significant weight gain of 5 kilograms in last six months. 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. [94]. 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. 2007 Oct;23(10):1133.e1-4. Arthroscopic management of a posterior femoral condyle (Hoffa) fracture: surgical technique. [100]. [12,13] Most researchers[2,7,14] currently believe that when the knee is in 90 of flexion and emergency braking is performed while driving a car, an axial force in either a varus or valgus direction is transferred from the proximal femur to the femoral condyle. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. [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. [34] The clinical diagnosis of a Hoffa fracture relies on trauma history, physical examination, imaging, and other objective indicators as well as increased suspicion based on the history and positive signs.[35,36]. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. Objective: To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. An attempt to treat Hoffa fractures under arthroscopy: A case report. J Orthop Surg 2017;25:17. This approach can also be used to treat comminuted fractures or complex Hoffa fractures.[18]. [13] There are also many reports on OCF in non-weight-bearing area of LFC. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. [43]. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. [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. The Letenneur classification, computed tomography (CT) classification, the AO classification, and the AO classification with supplement are widely used in clinics to categorize Hoffa fractures. [20]. Would you like email updates of new search results? Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. Smith EJ, Crichlow TP, Roberts PH. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. The risk of blood vessel damage when using this approach is minimal but the common peroneal nerve should be isolated first. Impaction Fracture of the Medial Femoral Condyle - JOSPT [74]. McDonough PW, Bernstein RM. [19]. 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Osteochondral defect | Radiology Reference Article | Radiopaedia.org Keyword Highlighting Letenneur J, Labour PE, Rogez JM, et al. Arthroscopy-assisted fracture fixation. [84]. Radiographs of knee joint show loose body in joint. Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. Soni A, Sen RK, Saini UC, et al. Please try after some time. Technique for Treatment of Subchondral Compression Fracture of the For tibial fractures, the use of bone plates or intramedullary nails is recommended if the condition of the local soft tissue is suitable. Unauthorized use of these marks is strictly prohibited. [3]. Management of condylar fractures - PubMed According to the internal fixation principle, the antiglide plate should be fixed in the posterior position. 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. Based on plate position, screws can be combined with a lateral antigliding plate[84] or a posterior antigliding plate.[55,87]. Neglected. Ann Chir 1978;32:2139. patellar margin thus corresponding to impaction injuries. Efficacy of multiple Acutrak hollow head compression screws in the, [68]. Sanders TG, Paruchuri NB, Zlatkin MB. [23]. Bali K, Mootha AK, Krishnan V, et al. 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 . Fracture surgery complications include: Acute compartment syndrome (ACS): A build-up of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage. 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. We report a case of patellar dislocation with OCF in the weight-bearing area of LFC. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. 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. 2017;84:4417. Search for Similar Articles Seeley MA, Knesek M, Vanderhave KL. 2001;17:5425. [10]. 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.
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