[60]. Tan et al[75] recommended an improved posterolateral approach starting from the space between the peroneal nerve and the biceps femoris. [61]. 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. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. 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. In the AO classification, Hoffa fracture is classified as type B3.2. ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. [6]. MRI of osteochondral defects of the lateral, [3]. Busam ML, Provencher MT, Bach BR. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. View Large Image Download Hi-res image Download (PPT) An unusual fracture of the lateral femoral condyle in a child. See this image and copyright information in PMC. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. [30]. modify the keyword list to augment your search. Zhou, Yabin MDa,b; Pan, Ying MDc; Wang, Qingxian MDa; Hou, Zhiyong MDa; Chen, Wei MDa,, aDepartment of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Orthopedic Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, bDepartment of Orthopedic Surgery, Shijiazhuang The Third Hospital. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. [72]. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. 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. Open bicondylar, [23]. We prospectively documented all potential cases of non-weight-bearing posterior subchondral impaction fractures of the femoral condyles diagnosed on magnetic resonance imaging (MRI) of the knee performed at our institution between January 2006 and December 2011. Type 2 fractures require a . Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. Research Article: Systematic Review and Meta-Analysis. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. Federal government websites often end in .gov or .mil. Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. Bethesda, MD 20894, Web Policies [10] Some of these patients may have a history of poliomyelitis that predisposes individuals to osteoporosis. Emerg Radiol 2015;22:3378. 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. J Trauma 2000;48:15960. 2013;185:61120. Neglected. Acta Chir Orthop Traumatol Cech. J Pediatr Orthop. Akan K, Akgun U, Poyanli O, et al. Published by Wolters Kluwer Health, Inc. Efficacy of multiple Acutrak hollow head compression screws in the, [68]. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. [37]. Materials and methods: This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Surgical versus nonsurgical treatments of acute primary patellar dislocation with special emphasis on the MPFL injury patterns. Injury 2005;36:8625. Buttress plating for a rare case of comminuted medial condylar. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. 2). Tripathy SK, Aggarwal A, Patel S, et al. Biau DJ, Schranz PJ. Radiographs of knee joint show loose body in joint. Wang JY, Liu Y, Li Y, et al. 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.) 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. This approach can also be used to treat comminuted fractures or complex Hoffa fractures.[18]. to maintaining your privacy and will not share your personal information without Sasidharan B, Shetty S, Philip S, et al. Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. 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. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. Rofo. Some error has occurred while processing your request. The patient was evaluated by the physical therapist 2 days after his injury. Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. You may search for similar articles that contain these same keywords or you may (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. Springerplus 2016;5:1164. [18]. Choudhary RK, Tice JW. Transverse Hoffa's or deep osteochondral fracture? Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. Your message has been successfully sent to your colleague. Would you like email updates of new search results? normal vital signs. Potini VC, Gehrmann RM. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. Vivek T, Saubhik Da, Sahil G, et al. 2001;17:5425. [21] In contrast to unicondylar Hoffa fracture, a bicondylar Hoffa fracture is caused by a posterior and upward directed force and is not associated with knee valgus. In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. Shah JN, Howard JS, Flanigan DC, et al. 2021 Jan 26;9(1):2325967120974649. doi: 10.1177/2325967120974649. [22]. With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. Osteochondral fractures of the lateral. Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. Acta Orthop Belg 2001;67:1328. Soft tissues are retracted to . The patient had no previous history of patella dislocation and pain around the knee. sharing sensitive information, make sure youre on a federal Comminuted fractures are a type of broken bone. Visual observation revealed significant right knee effusion and an inability to bear weight on the right lower extremity or flex his knee beyond 80. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. 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. 2017;30:37884. [50]. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. Matthewson MH, Dandy DJ. Rue JP, Busam ML, Detterline AJ, et al. Federlin M, Krifka S, Herpich M, et al. [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]. Khle J, Angele P, Balcarek P, et al. Intra-articular corrective osteotomy for malunited. [3,4] In 1888, Hoffa described coronal fracture of the femoral condyle but did not indicate the source of the previous reference. official website and that any information you provide is encrypted 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. Arthroscopy 2011;27:81724. Highlight selected keywords in the article text. FOIA Reconstructive osteotomy for a malunited medial. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. 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. 1 It has been proved that compression of the posterior border of . [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. Please try after some time. Gang et al[20] found that there was no statistically significant difference between surgical treatment and non-surgical treatment in patients with patellar side injury of medial collateral ligament of patella. J Knee Surg 2008;21:23540. Baker BJ, Escobedo EM, Nork SE, et al. (B) The suture of the lateral condyle of the femur is still fixed on the surface. Jabalameli M, Bagherifard A, Hadi H, et al. Bauer KL. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. You may be trying to access this site from a secured browser on the server. Cartilage. [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. 2). J Orthop Surg 2017;25:17. 2018;31:38291. [19] Therefore, lateral condyle fracture is significantly more common than medial condyle fracture. Starr AJ, Jones AL, Reinert CM. We used the key words Hoffa fracture and coronal fracture of femoral condyle for the knowledge. 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. Cancellous screws cannot achieve adequate compression[55] and require more surgical time to countersink. Arthroscopy 2012;28:13817. 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. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. Egol KA, Broder K, Fisher N, et al. 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. 2014;22:238895. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. Sanders TG, Paruchuri NB, Zlatkin MB. [51]. After the incision was closed in layers, the lower limb was splinted for 6 weeks, isometric exercises for the quadriceps began the day after surgery. Epub 2020 Sep 18. [40]. Ul Haq R, Modi P, Dhammi I, et al. A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. doi: 10.1097/MD.0000000000032104. Injury 2018;49:398403. [5]. Lewis SL, Pozo JL, Muirhead-Allwood WF. 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. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. [94]. Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. Z Orthop Ihre Grenzgeb. 1986;14:11720. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). Clinical outcomes after absorbable suture fixation of patellar, [26]. Radiographic appearance Jarit GJ, Kummer FJ, Gibber MJ, et al. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. FIGURE 2. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. For Letenneur II and some Letenneur III fractures close to the posterior cortex of the femoral condyle, cannulated lag screw fixation is commonly used. [91]. J Knee Surg. Meta plate and cannulated screw fixation for, [86]. 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. HHS Vulnerability Disclosure, Help Appointments 216.444.2606. After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. During the operation, we found that 2.5*2. Internal fixation with headless compression screws and back buttress plate for. This sign represents a severe bone contusion caused by impression, and microfracturing, visible on MRI, and is suspect for an impacted (osteo)chondral fracture due to a tear of . [96]. [59]. Intra-articular dislocation of the patella. [18]. 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. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. 2003;19:71721. Epub 2007 Mar 23. [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. [58]. Maenpaa H, Huhtala H, Lehto MU. [9]. At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: Reduce Pain Restore Movement Optimise Recovery What are Femoral Condyle Fractures? 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). Acute patellar dislocation in children and adolescents: a randomized clinical trial. . [14,15] Diederichs et al[16] suggest that a first patellar dislocation is often treated conservatively, and loose body removal, microfracture and internal fixation should be selected according to the size and location of osteochondral block.
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