2021. Westmoreland GL, McLaurin TM, Hutton WC. National Library of Medicine Efficacy of multiple Acutrak hollow head compression screws in the, [68]. [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. Onay T, Glabi D, olak , et al. Disclaimer. [29]. Orthop J Sports Med. Patellar dislocation with OCF in weight-bearing area of LFC is a rare injury in adolescents. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with [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. Neglected. Manfredini M, Gildone A, Ferrante R, et al. 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. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. FIGURE 2. normal vital signs. Osteochondral Fracture Lateral Femoral Condyle Treated with - Hindawi Cartilage. Appointments 216.444.2606. Posterior wall blowout in anterior cruciate ligament reconstruction: avoidance, recognition, and salvage. findings identifies vascular segments with diminished flow vascular injury 2023 Jan;15(1):103-110. doi: 10.1111/os.13586. Malunion: This happens when your broken bones don't line up correctly while they heal. [2]. The term comminuted fracture refers to a bone that is broken in at least two places. Surgically treated Hoffa Fractures with poor long-term functional results. Mashoof et al[11] reported 7 cases of OCF in the weight-bearing area of LFC caused by patellar dislocation, of which 3 cases were treated with bioabsorbable screw fixation, but the follow-up results were not reported. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. Xray examination of right knee joint: free bone mass can be seen at the anterior edge of the femur in the knee joint. Intra-articular corrective osteotomy for malunited. Technique for Treatment of Subchondral Compression Fracture of the Zeebregts CJ, Zimmerman KW, ten Duis HJ. [92]. 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]. Busam ML, Provencher MT, Bach BR. 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. 2017;30:37884. Data is temporarily unavailable. Careful consideration and attention to the principles of fracture management, and the role of the condyle as an articulating . Please try after some time. [19]. On lateral radiographs, the normal femoral condyles overlap, and bone cortex interruption may not be visible. Z Orthop Ihre Grenzgeb. Sun H, He QF, Huang YG, et al. Conjoint bicondylar, [22]. Arthroscopy-assisted fracture fixation. Jiang YR, Wang ZY, Zhang DB, et al. [77]. See this image and copyright information in PMC. Your message has been successfully sent to your colleague. Mashoof AA, Scholl MD, Lahav A, et al. Antigliding plating for Letenneur type I Hoffa fractures. Zhao LL, Tong PJ, Xiao LW. Arthroscopic. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. Acta Orthop Scand 1997;68:4246. 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. [21]. Shah JN, Howard JS, Flanigan DC, et al. You may be trying to access this site from a secured browser on the server. [36]. Rev Chir Orthop Reparatrice Appar Mot. Intra-operative fractures in primary total knee arthroplasty - a Transverse Hoffa's or deep osteochondral fracture? Ercin E, Baca E, Kural C. Arthroscopic. Shetty GM, Wang JH, Kim SK, et al. patellar margin thus corresponding to impaction injuries. During the operation, 2 4.5mm anchor (Smith @ nephew TIWNFIX Ultra PK Suture Anchor) was inserted into the posterior edge and medial edge of the cartilage mass in the weight-bearing area, and then 2 non-absorbable sutures on each anchor were replaced by an absorbable suture (ETHICON VICRYL PLUS VCP359H), and finally the 2 ends of the absorbable suture were knotted to prevent sliding. Ostermann PA, Neumann K, Ekkernkamp A, et al. J Knee Surg 2013;26(Suppl 1):S8993. Baker BJ, Escobedo EM, Nork SE, et al. Lateral radiographs of the affected knee were inspected for a . 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. [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. The most common way to fracture the femoral condyles is jumping from a large height. Werner BC, Miller MD. Your message has been successfully sent to your colleague. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. 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. Intertrochanteric femoral fractures occur mostly in the elderly, and the average age of onset is 66-76 years. 4). [9] The pain due to these combined injuries often exceeds that caused by the Hoffa fracture, which can lead physicians to miss the latter. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. J Pediatr Orthop B, 2013, 22: 344349. 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 . 1982;68:31725. Epub 2022 Nov 15. Cheng S, Zaidi SF, Linnau KF. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. Intertrochanteric Fractures of the Femur | SpringerLink Bicondylar. The knee joint is placed in flexion during surgery,[65,66] placing the joint capsule and gastrocnemius in a relaxed state, which reduces the traction on the fracture and is conducive to fracture repair. With a lower degree of knee flexion, the extensor mechanism is damaged below the patella (patellar tendon); at higher angles, the quadriceps tendon is torn. Acta Orthop Traumatol Turc. Bone contusion and associated meniscal and medial collateral - PubMed [18]. [7]. The site is secure. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. Injury 1989;20:3714. Subchondral impaction fractures of the non-weight-bearing - PubMed Orbital blow-out fracture | Radiology Reference Article | Radiopaedia.org Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. Keyword Highlighting [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. osteochondral impaction fracture postsurgical (e.g. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. computed tomography scan and magnetic resonance (MRI) examination of knee joint further confirmed loose body within the knee joint, osteochondral defect in weight-bearing area of LFC and avulsion of medial patellofemoral ligament (Fig. [3,4] In 1888, Hoffa described coronal fracture of the femoral condyle but did not indicate the source of the previous reference. 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. (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. [96]. Operative. [30]. 2). Lian X, Zeng YJ. 2020 Jun 15;9 (6):e823-e828. A fracture is a broken bone. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. What is an Impact Fracture? - Definition from Corrosionpedia 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. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Sahu RL, Gupta P. Operative management of, [44]. [6]. 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. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. [58]. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Kapoor C, Merh A, Shah M, et al. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. [24]. Biau DJ, Schranz PJ. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. [21]. Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout: a cadaveric study. Jarit GJ, Kummer FJ, Gibber MJ, et al. 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. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. A swashbuckler approach[34,72] can be used to treat bicondylar Hoffa fractures because it protects the Quadriceps femoris abdomen during surgery, allowing quick postoperative recovery of muscle strength and range of motion. 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. Medial and lateral buttressing may be required if either fracture extends proximally in the same plane. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. government site. [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. A patient, 15-year-old, female student. Careers. If fractures are present they are usually associated with orbital rim or other significant craniofacial injuries. You may search for similar articles that contain these same keywords or you may Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. Radiography can reveal fracture lines. Humerus Fracture: Types, Symptoms & Treatment - Cleveland Clinic 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. Get new journal Tables of Contents sent right to your email inbox, December 16, 2022 - Volume 101 - Issue 50, Creative Commons Attribution License 4.0 (CCBY), Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report, Articles in Google Scholar by Liang Wu, MM, Other articles in this journal by Liang Wu, MM, Benign optic nerve gliomas in an adult: A case report, Analysis of the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture: A review, A bibliometric and emerging trend analysis on stress granules from 2011 to 2020: A systematic review and bibliometrics analysis, Inhaled opioids for cancer pain relief: A narrative review, Primary seminoma of prostate in a patient with Klinefelter syndrome: A case report, Privacy Policy (Updated December 15, 2022). Suture anchors are drilled into the posterolateral tibia to repair the meniscus to the meniscosynovial junction. Rue JP, Busam ML, Detterline AJ, et al. J Orthop Trauma 2002;16:17881. Therefore, further studies are needed to improve the quality of Hoffa fracture reduction under arthroscopy. (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. You will need surgery to repair your bone, and recovery can take a year or longer. Published by Wolters Kluwer Health, Inc. J Orthop Surg 2017;25:17. ;Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. Potini VC, Gehrmann RM. Internal fixation with headless compression screws and back buttress plate for. 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. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. (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. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. Lewis SL, Pozo JL, Muirhead-Allwood WF. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. The patient was referred to an or- thopaedic surgeon, who recommended conservative management. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. Rosenberg NJ. Osteochondral fractures of the lateral. Braune C, Rehart S, Kerschbaumer F, Jger A. We replaced the anchor suture with (ETHICON VICRYL PLUS VCP 359H) suture during the operation, which is an attempt based on the research of Li,[25] in order to avoid the second operation. Introduction. Hoffa fragment associated with a femoral shaft fracture. Twenty-seven-year nonunion of a. Medline, Embase, the Cochrane Library, Google Scholar, the China National Knowledge Infrastructure, and the China Biology Medicine disc were searched for relevant articles. [15]. You may be trying to access this site from a secured browser on the server. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence Unfallchirurg 2004;107:1521. The work cannot be changed in any way or used commercially without permission from the journal. The patient was evaluated by the physical therapist 2 days after his injury. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. (C) The free edge of the anterior foot of the meniscus was rough (degree I). For more information, please refer to our Privacy Policy. 2017;84:4417. 2003;19:71721. [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. Chin J Traumatol. For more information, please refer to our Privacy Policy. -, Morris John K, Weber Alexander E, Morris Mark S. Adolescent femoral chondral fragment fixation with polyLlactic acid chondral darts. Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. Suture anchor system is mostly used to repair rotator cuff and patellar tendon. Cancellous screws cannot achieve adequate compression[55] and require more surgical time to countersink. [102]. [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. Impact fractures can be classified either as ductile or brittle depending on the elongation pattern that is present. Intra-articular dislocation of the patella with associated, [26]. 2001;17:5425. Type III is an oblique fracture of the femoral condyle with the fracture line located anterior to the joint capsule, anterior cruciate ligament, lateral collateral ligament, popliteal tendon, and the lateral head of the gastrocnemius muscle. Chin J Orthop Trauma 2009;9:8503. The patient felt pain in his right knee and limited movement. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. * Correspondence: Lijiang He, Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Hangzhou, Zhejiang 311121, China (e-mail: [emailprotected]). Three types of fracture are defined based on the coronal fracture line (Fig. Depression Of more than 5 mm in a type 3 fracture can treated by elevation from below and (d' supported by bone grafts and fixation. Nandy K, Raman R, Vijay RK, et al. Somford MP, van Ooij B, Schafroth MU, et al. Distal Femur (Thighbone) Fractures of the Knee - OrthoInfo - AAOS At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: Reduce Pain Restore Movement Optimise Recovery What are Femoral Condyle Fractures? [5]. Technique for Treatment of Subchondral Compression Fracture of the Technique of reduction and fixation of unicondylar medial, [70]. In these cases, avulsion of the anterior cruciate ligament along with a large chunk of bone at its insertion[17] can lead to a Hoffa fracture. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. [37]. Two cartilage masses can be seen during the operation. [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. Impaction Fracture of the Medial Femoral Condyle - JOSPT At present, open reduction is often used to treat osteochondral fractures. Dhillon MS, Mootha AK, Bali K, et al. [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. Reconstructive osteotomy for a malunited medial. At present, open reduction is often used to treat osteochondral fractures. Irreducible, incarcerated vertical dislocation of patella into a. The goals of treatment include restoration of function and esthetics. 3). [100]. Xu Y, Li H, Yang HH, et al. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. J Orthop Surg Res 2012;7:21. J Orthop Trauma 1999;13:13840. 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. After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. HHS Vulnerability Disclosure, Help White EA, Matcuk GR, Schein A, et al. Objective: To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. [78]. This article discusses anatomic considerations, classification of condylar fractures, indications for surgery, treatment options, and complications. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. [94]. [101]. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. 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. A case report. 1). Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. Dejour H, Walch G, Nove-Josserand L, et al. [4]. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. Subchondral fracture | Radiology Reference Article | Radiopaedia.org 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. Sasidharan B, Shetty S, Philip S, et al. 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. Management of any globe injury generally takes precedence over fractures 1. Transverse Hoffa's or deep osteochondral fracture? [48]. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. [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. 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. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. Pathology. [50]. J Knee Surg. Acta Biomater, 2019, 93:222238. [5]. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity 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). The swashbuckler: a modified anterior approach for fractures of the distal femur. Tripathy SK, Aggarwal A, Patel S, et al. Intra-articular dislocation of the patella. Impact fractures are due to track formation and propagation. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures.
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