Factors of patellar instability: an anatomic radiographic study. Tong W, Yang J, Xu PL, et al. Federal government websites often end in .gov or .mil. Jarit GJ, Kummer FJ, Gibber MJ, et al. [29]. The specific mechanism of a Hoffa fracture is not well understood. In these fractures, the popliteus tendon and the lateral head of the gastrocnemius muscle remain attached to the fragment. Surgical treatment of femoral medial condyle fracture with lag screws Wolters Kluwer Health Chin J Traumatol 2011;14:1436. A comparison of the clinical effect of two fixation methods on Hoffa fractures. Arthroscopy 2011;27:81724. 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. Gesslein M, Merkl C, Bail HJ, et al. The patient was evaluated by the physical therapist 2 days after his injury. Seeley MA, Knesek M, Vanderhave KL. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. [50]. Before 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. Operative, [46]. Skeletal Radiol 2015;44:3743. Potini VC, Gehrmann RM. 1). This kind of disease is commonly seen in the knee joint sprain during strenuous activity. 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. Arastu MH, Kokke MC, Duffy PJ, et al. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . Complications of humerus fracture treatment. Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. Surgically treated Hoffa Fractures with poor long-term functional results. Distal Femur (Thighbone) Fractures of the Knee - OrthoInfo - AAOS 1994;2:1926. J Orthop Trauma 2006;20:2736. osteochondral impaction fracture postsurgical (e.g. [90]. Sasidharan B, Shetty S, Philip S, et al. Long term results of unicondylar fractures of the femur. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. [102]. 1). Please enable scripts and reload this page. 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. Lateral femoral notch sign (knee) | Radiology Reference Article Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. Hoffa fracture of the femoral condyle: Injury mechanism, : Medicine PDF ssslideshare.com Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. 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. Distal pulses and sensation were intact. Complications of anterior cruciate ligament reconstruction with bone-patellar tendon-bone constructs: care and prevention. Reconstructive osteotomy for a malunited medial. [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]. 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. Rofo. normal vital signs. Surgical treatment of femoral medial condyle fracture with lag screws Redislocation in 37/75 patients followed for 6-24 years. modify the keyword list to augment your search. J Bone Joint Surg Am 2006;88:22704. Segmentation of the lateral femoral notch sign with MRI using a new Tripathy SK, Aggarwal A, Patel S, et al. 2). Frangakis EK. Medicine (Baltimore). Orthop J Sports Med. [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. Ji G, Wang S, Wang X, et al. [64]. Arthroscopic; Internal fixation; Osteochondral fracture; Suture anchor; TWINFIX Ti. [42] Compared with anteroposterior and lateral films, oblique radiographic views can show minimally displaced fractures better[14] and can, therefore, be used as a routine examination method for a Hoffa fracture. You may search for similar articles that contain these same keywords or you may [75]. According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. [61]. 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. -. [105]. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. White EA, Matcuk GR, Schein A, et al. The anatomical plate for distal medial condyle fracture of femur should be developed as soon as possible. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. Khle J, Angele P, Balcarek P, et al. [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. Highlight selected keywords in the article text. Technique for Treatment of Subchondral Compression Fracture of the and transmitted securely. Wang JY, Liu Y, Li Y, et al. [41]. 1982;68:31725. [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. Emerg Radiol 2015;22:3378. Li ZX, Song HH, Wang Q, et al. eCollection 2020 Jun. 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. [93]. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [66]. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. The Authors. Hoffa nonunion, two cases treated with headless compression screws. Repair of displaced partial articular fracture of the distal femur: the. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. Surgical, [71]. Knee Surg Sports Traumatol Arthrosc. [4]. [82]. Malays Orthop J 2017;11:204. Lian X, Zeng YJ. Bartonicek J, Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. Viskontas DG, Nork SE, Barei DP, et al. 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. Some error has occurred while processing your request. Caton J, Deschamps G, Chambat P, et al. An unusual fracture of the lateral femoral condyle in a child. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. Hawkins et al[18] found that the recurrent dislocation rate of patients with primary patellar dislocation is related to congenital femoral trochlear dysplasia, high patellar position and large TT-TG. Accessibility 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. This approach can also be used to treat comminuted fractures or complex Hoffa fractures.[18]. FIGURE 2. Shah JN, Howard JS, Flanigan DC, et al. Dejour H, Walch G, Nove-Josserand L, et al. Acute patellar dislocation in children and adolescents: a randomized clinical trial. Please enable scripts and reload this page. absorbable internal fixation; dislocation of patella; femoral condyle; osteochondral fracture. 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. [Patella infera. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. Nonunion of coronal shear fracture of femoral condyle. 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. Suture anchors are drilled into the posterolateral tibia to repair the meniscus to the meniscosynovial junction. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with For more information, please refer to our Privacy Policy. [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. Intra-articular corrective osteotomy for malunited. Preliminary X-ray examination showed osteochondral defects of LFC and loose body in knee joint (Fig. [100,101] To avoid damaging the cartilage in these cases, it is important to reduce the patella early and restore the patellofemoral joint stability by repairing the damaged medial soft tissues. 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]. Making the diagnosis of a Hoffa fracture is challenging. 1996 ). Int Orthop. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Orbital blow-out fracture | Radiology Reference Article | Radiopaedia.org The authors have no funding and conflicts of interest to disclose. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. (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. Osteochondral injuries of the knee in pediatric patients. The patient was referred to an or- thopaedic surgeon, who recommended conservative management. [103]. [Treatment of extensive chondral defects of the patella after patellar dislocation]. J Trauma 2000;48:15960. McDonough PW, Bernstein RM. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Keyword Highlighting Transverse Hoffa's or deep osteochondral fracture? patellar margin thus corresponding to impaction injuries. [9]. Starr AJ, Jones AL, Reinert CM. Please enable it to take advantage of the complete set of features! Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. However, the latest biomechanical study[88] showed that lateral antiglide plate has greater anti-shearing strength than posterior fixation. 4). This article discusses anatomic considerations, classification of condylar fractures, indications for surgery, treatment options, and complications. 2023 Jan;15(1):103-110. doi: 10.1111/os.13586. Akan K, Akgun U, Poyanli O, et al. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. [91]. In general, there has been a trend toward . Sahu RL, Gupta P. Operative management of, [44]. 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. We searched Medline, Embase, Cochrane Library, Google Scholar, China National Knowledge Infrastructure, and China Biology Medicine disc, using the terms Hoffa fracture and coronal fracture of femoral condyle.. 2001;17:5425. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. [48]. Werner BC, Miller MD. Keywords: Intertrochanteric Fractures of the Femur | SpringerLink [65]. J Knee Surg 2008;21:23540. 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). Manfredini M, Gildone A, Ferrante R, et al. Tsai CH, Hsu CJ, Hung CH, et al. [95]. Xray examination of right knee joint: free bone mass can be seen at the anterior edge of the femur in the knee joint. Non-union coronal fracture femoral condyle, sandwich technique: a case report. (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. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. If fractures are present they are usually associated with orbital rim or other significant craniofacial injuries. your express consent. In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. At present, open reduction is often used to treat osteochondral fractures. 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. Nonunion of a, [62]. Clinical outcomes after absorbable suture fixation of patellar, [26]. Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro. Distal femur fractures most often occur either in older people whose bones . 8600 Rockville Pike may email you for journal alerts and information, but is committed 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. Intraoperative, [12]. Gerdy's tubercle osteotomy for the, [69]. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Subchondral fracture | Radiology Reference Article | Radiopaedia.org Vivek T, Saubhik Da, Sahil G, et al. J Knee Surg. A fracture is a broken bone. [57]. (C) The free edge of the anterior foot of the meniscus was rough (degree I). Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. Injury 2011;42:14958. [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. Musculoskelet Surg 2012;96:4954. J Orthop Surg Res 2012;7:21. . 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. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. J Knee Surg 2013;26(Suppl 1):S8993. Lewis SL, Pozo JL, Muirhead-Allwood WF. 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. [2,77] The heads of screws placed through the articular cartilage are countersunk to prevent damage to the cartilage. 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. Knee 2004;11:1257. [93] The biggest challenge in the treatment of Hoffa fractures under arthroscopy due to the patella is dissecting the fragments for reduction[94] and placing screws perpendicularly into the fracture line. [24]. A rare case of unicondylar medial, [24]. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. Choudhary RK, Tice JW.
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