Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Please enable it to take advantage of the complete set of features! 2020 Jun 15;9 (6):e823-e828. The .gov means its official. [56]. [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. Bali K, Mootha AK, Krishnan V, 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. Anchor absorbable suture bridge fixation is rigid enough, which can avoid second operation, save cost and good outcome could be expected, which is worth exploring; Of course, a large number of clinical data are needed for further comparative study. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. 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. [7]. Orbital blow-out fracture | Radiology Reference Article | Radiopaedia.org Surgically treated Hoffa Fractures with poor long-term functional results. Ann Chir 1978;32:2139. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. A lateral incision plus Gerdy tubercle osteotomy provides full exposure[68] especially in cases of coronal fracture of the lateral condyle. Your message has been successfully sent to your colleague. 2014;22:238895. 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. Tan Y, Li H, Zheng Q, et al. 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. Arthroscopic-assisted fixation of. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). The patient was referred to an or- thopaedic surgeon, who recommended conservative management. Knee Surg Sports Traumatol Arthrosc 2011;19:3209. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with [64] Open reduction and internal fixation is the 1st choice for the treatment of displaced Hoffa fractures, and it is also suitable for the treatment of nondisplaced Hoffa fractures. For local soft-tissue injuries, external fixation can be used, but this may delay the time to mobility restoration and affect therapeutic efficacy. Please enable scripts and reload this page. [50]. 2021 Jan 26;9(1):2325967120974649. doi: 10.1177/2325967120974649. [15,1720] The fracture line its inclination angle of a Hoffa fracture depend on the degree of knee joint flexion at the time of trauma[18]; as the angle of knee flexion increases, the fracture line will occur farther from the posterior cortex of the femoral-condyle. Screw insertion direction differs among operative approaches. For more information, please refer to our Privacy Policy. 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. Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. Min L, Tu CQ, Wang GL, et al. Knee Surg Sports Traumatol Arthrosc. Medicine 2022;101:50(e32104). Segmentation of the lateral femoral notch sign with MRI using a new Shetty GM, Wang JH, Kim SK, et al. Matthewson et al[10] believe OCF in weight-bearing area of LFC with patellar dislocation is caused by the shearing forces between the LFC and the lateral tibial plateau as they pivot under load. At present, open reduction is often used to treat osteochondral fractures. 1). McCarthy JJ, Parker RD. The term comminuted fracture refers to a bone that is broken in at least two places. Arthroscopic. (A) Use of anterior cruciate ligament locator to assist drilling at the distal end of the femur. [41]. Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. Comminuted fractures are caused by severe traumas like car accidents. Epub 2018 Oct 4. 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. Lee et al[13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. [58]. Intra-articular corrective osteotomy for malunited. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). Transverse Hoffas or deep. Jain A, Agrawal P, Chadha M, et al. Rue JP, Busam ML, Detterline AJ, et al. The Authors. doi: 10.1016/j.arthro.2006.11.029. Three days after injury, the lateral parapatellar incision of the right knee was performed under general anesthesia, OCF reduction and fixation of the lateral condyle was performed. Incarcerated patellar tendon in. Fractures of the distal femur typically occur in the axial and sagittal planes. Intra-operative fractures in primary total knee arthroplasty - a Knee Surg Sports Traumatol Arthrosc. 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. A high-energy injury resulting in a Hoffa fracture of the medial condyle is often associated with a tibia fracture,[18] a bicondylar Hoffa fracture,[44,45] a dislocation of the patella,[14] a knee dislocation,[46] intercondylar and supracondylar fractures,[9,47] and pelvic[48,49] and femoral shaft fractures. Subchondral insufficiency fracture of the knee: a non-traumatic injury Management of condylar fractures - PubMed Published by Wolters Kluwer Health, Inc. [27]. Federal government websites often end in .gov or .mil. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. Sasidharan B, Shetty S, Philip S, et al. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. 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 . Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. [96]. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. [18]. 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). Fracture and dislocation compendium: Orthopaedic Trauma Association Committee for Coding and, [35]. Please try again soon. Khle J, Angele P, Balcarek P, et al. Shah JN, Howard JS, Flanigan DC, et al. Egol KA, Broder K, Fisher N, et al. Antigliding plating for Letenneur type I Hoffa fractures. Wu P, WB, Kong LC, et al. Jiang YR, Wang ZY, Zhang DB, et al. You may be trying to access this site from a secured browser on the server. J Orthop Trauma 2002;16:17881. femoral shaft fracture presentation The patient had an uneventful postoperative recovery. Cartilage. A 15-year-old female student accidentally sprained her right knee while participating in sports activities. Comminuted Fracture: Symptoms, Causes & Treatment - Cleveland Clinic FOIA Operative, [46]. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. [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. Seeley MA, Knesek M, Vanderhave KL. Arthroscopy-assisted fracture fixation. Ostermann PA, Neumann K, Ekkernkamp A, 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. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. Methods All patients with post-injury bi-plane radiographs and MRI images after sustaining a tear to the anterior cruciate ligament were included. National Library of Medicine AIMER was located at the outlet of the medial bone canal of the lateral condyle of the femur, and the HANDLE was adjusted to a suitable angle (5060). (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Appointments 216.444.2606. The distal femur is where the bone flares out like an upside-down funnel. Miyamoto R, Fornari E, Tejwani NC. A patient, 15-year-old, female student. A review of 23 patients. [53] In addition, partial nondisplaced Hoffa fractures are difficult to diagnose on anteroposterior and lateral views of the knee because the fracture lines often overlaps the side or lateral condyle, which can result in a missed diagnosis in as many as 30% of cases.[9,18]. Your message has been successfully sent to your colleague. Hoffa fractures are caused by shear stress between the femoral condyle and tibial plateau. Search for Similar Articles Internal fixation with headless compression screws and back buttress plate for. J Knee Surg 2008;21:23540. Arthroscopy 1996;12:2247. Onay T, Glabi D, olak , et al. Mashoof AA, Scholl MD, Lahav A, et al. Femoral Condyle Fractures - Symptoms, Causes, Treatment | Physio Callewier A, Monsaert A, Lamraski G. Lateral. 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. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. 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 patient felt pain in his right knee and limited movement. Acute patellar dislocation in children and adolescents: a randomized clinical trial. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Open bicondylar, [23]. 2013;185:61120. Some error has occurred while processing your request. [25]. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. Letenneur J, Labour PE, Rogez JM, et al. Heuschen UA, Gohring U, Meeder PJ. Dave LY, Nyland J, Caborn DN. Jarit GJ, Kummer FJ, Gibber MJ, et al. Sun H, He QF, Huang YG, et al. [25] A cannulated screw combined with a plate is recommended in these cases. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Please try again soon. [103]. [76]. [7]. [16]. Sanders TG, Paruchuri NB, Zlatkin MB. Transverse Hoffa's or deep osteochondral fracture? An unusual fracture of the lateral femoral condyle in a child. 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. Gerdy's tubercle osteotomy for the, [69]. In these fractures, the popliteus tendon and the lateral head of the gastrocnemius muscle remain attached to the fragment. Li R, Guo G, Chen B, Zhu L, Lin A. Arthroscopicallyassisted reduction and fixation of an old osteochondral fracture of the lateral femoral condyle. Starr AJ, Jones AL, Reinert CM. Report of 20 cases [in French]. For tibial fractures, the use of bone plates or intramedullary nails is recommended if the condition of the local soft tissue is suitable. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. [64]. Two patients with osteochondral injury of the weight-bearing portion of the lateral. [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. A case report. 2021. [6]. to maintaining your privacy and will not share your personal information without 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]. [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. Keyword Highlighting [25] Loss of bone matrix results in brittle, weaker bones that break rather than bend with external force. Tripathy SK, Aggarwal A, Patel S, et al. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. However, the latest biomechanical study[88] showed that lateral antiglide plate has greater anti-shearing strength than posterior fixation. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. [6]. Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. Long term results of unicondylar fractures of the femur. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. Internal fixation with lag screws plus an antigliding plate for the, [88]. During complete anterior cruciate ligament (ACL) tears in pivoting mechanisms, the area of the lateral femoral condyle (LFC) localized just above the anterior third of the lateral meniscus (LM) impacts the posterior border of the lateral tibial plateau (LTP), which may result in a subchondral compression fracture. [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. Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. [10]. Meyer C, Enns P, Alt V, et al. If fractures are present they are usually associated with orbital rim or other significant craniofacial injuries. MRI of osteochondral defects of the lateral, [3]. For simple lateral condylar Hoffa fractures, a patellar anterolateral approach is most commonly used. Fracture of the Lateral Femoral Condyle | Journal of Orthopaedic Am J Sports Med 2008;36:37994. J Pediatr Orthop. [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. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. [104]. [51]. (B) 1.5cm1.5cm free bone was found in the knee joint cavity, and the bone fracture was intact. 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. Based on plate position, screws can be combined with a lateral antigliding plate[84] or a posterior antigliding plate.[55,87]. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. McDonough PW, Bernstein RM. FIGURE 1. Arthrosc Tech 2015;4:e299303. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). Lateral femoral notch sign (knee) | Radiology Reference Article [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. Materials and methods: This HIPAA-compliant retrospective study was approved by our Institutional Review Board. [31]. 2021;13(1_suppl):966S73S. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd. Xray examination of right knee joint: free bone mass can be seen at, (A) MRI examination of the right knee joint: the bone continuity at the, (A) The fresh 1.5 cm 1.5 cm fracture surface of the lateral, (A) One 1.5 mm Kirschner wire temporarily fixed the fracture block of the, (A) Use of anterior cruciate ligament locator to assist drilling at the distal, (A) Through the hollow needle channel of the femoral intercondylar fossa, the folding, Surgical diagrams (A: osteochondral fracture, Surgical diagrams (A: osteochondral fracture of the lateral femoral condyle; B: fixation of, CT examination 6 months after operation: one screw internal fixation, regular external condyle, (A) A blurred fracture line can be seen at the fracture of the, MeSH Ji G, Wang S, Wang X, et al. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. Subchondral Impaction Fractures of the Medial Femoral Condyle in - LWW Keywords: Bethesda, MD 20894, Web Policies This site needs JavaScript to work properly. Unable to load your collection due to an error, Unable to load your delegates due to an error. [94]. Lateral-view radiograph of the left knee demonstrating an abnormally deep depression of the medial condylopatellar sulcus (arrow). Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. (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. Technique of reduction and fixation of unicondylar medial, [70]. 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). Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. 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. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with FIGURE 2. Orthopedics, 2016, 39: e362e366. Irreducible, incarcerated vertical dislocation of patella into a. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. 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. Soft tissues are retracted to . Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. [33] Dua and Shamshery[34] proposed a classification method that supplements the AO classification with proper surgical planning to optimize outcomes. Subchondral insufficiency fracture of the knee - Radiopaedia modify the keyword list to augment your search. [61]. J Surg Case Rep 2012;2012:10. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. [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. 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. Careers. 3). [Patella infera. Search for Similar Articles 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. Medline, Embase, the Cochrane Library, Google Scholar, the China National Knowledge Infrastructure, and the China Biology Medicine disc were searched for relevant articles. Arthroscopy 2012;28:13817. 2020 The Authors. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. Osteochondral fractures of the lateral. Palmu S, Kallio PE, Donell ST, et al. [80]. A case report. eCollection 2021 Jan. Uimonen MM, Repo JP, Huttunen TT, Nurmi H, Mattila VM, Paloneva J. Knee Surg Sports Traumatol Arthrosc. Tsai CH, Hsu CJ, Hung CH, et al.
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