[17,18] Magnetic resonance imaging (MRI) should be performed when injury is suspected to the meniscus, cruciate ligament, collateral ligament, or other soft tissues to determine the extent of injury,[32] develop appropriate surgical plans, and accurately assess prognosis. Medline, Embase, the Cochrane Library, Google Scholar, the China National Knowledge Infrastructure, and the China Biology Medicine disc were searched for relevant articles. Mashoof AA, Scholl MD, Lahav A, et al. 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 mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). Open reduction and internal fixation are preferred. YZ and YP contributed equally to this work. [66]. Apropos of 128 cases]. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. 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. Meyer C, Enns P, Alt V, et al. J Orthop Surg 2017;25:17. 2017;84:4417. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. [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. Repair of displaced partial articular fracture of the distal femur: the. 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. Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro. Int Orthop 2015;39:124550. The distal femur is the area of the leg just above the knee joint. Research Article: Systematic Review and Meta-Analysis. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Surg Case Rep 2012;2012:10. Rosenberg NJ. Injury 2005;36:8625. Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa's fracture with patellar dislocation - a rare case. You may search for similar articles that contain these same keywords or you may J Knee Surg 2013;26(Suppl 1):S8993. 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. Singh AP, Dhammi IK, Vaishya R, et al. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. Osteochondral fractures of the lateral. Published by Wolters Kluwer Health, Inc. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. Impact fractures are due to track formation and propagation. 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. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. Somford et al[65] showed that the repair strength of absorbable screw fixation is weak, knee joint activity produces greater shear stress, and there is a risk of screw breakage; thus, careful selection of the surgical plan is recommended. What is an Impact Fracture? - Definition from Corrosionpedia After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Surgical treatment of femoral medial condyle fracture with lag screws Nakagawa S, Arai Y, Inoue H, et al. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Unfallchirurg 2004;107:1521. [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. [9]. In addition to changes in bone mineral composition and a reduced proportion of bone matrix in patients with osteoporosis, changes in bone microstructure, thinning of bone cortex, and reduction in the number and size of bone trabeculae result in a decreased bone load capacity[26] and an increased risk of a Hoffa fracture with low-energy trauma. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. 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 . [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. [95]. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. 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. The white arrow indicate the defect area. However, the latest biomechanical study[88] showed that lateral antiglide plate has greater anti-shearing strength than posterior fixation. For bicondylar fractures, a median parapatellar incision can be used. Unicondylar femoral fractures: therapeutic strategy and long-term results. 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. [42]. Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. Nonunion of a. However, some patients had suture removal during the second arthroscopy because of suture irritation. J Bone Joint Surg Am 2006;88:22704. 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. [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. femoral shaft fracture presentation [10] Some of these patients may have a history of poliomyelitis that predisposes individuals to osteoporosis. [33] Dua and Shamshery[34] proposed a classification method that supplements the AO classification with proper surgical planning to optimize outcomes. Springerplus 2016;5:1164. Neglected. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Lateral femoral notch sign (knee) | Radiology Reference Article Subchondral insufficiency fracture of the knee: a non-traumatic injury An official website of the United States government. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. Management of any globe injury generally takes precedence over fractures 1. Type 2 fractures require a . Li ZX, Song HH, Wang Q, et al. Intra-articular dislocation of the patella. Intra-articular corrective osteotomy for malunited. An attempt to treat Hoffa fractures under arthroscopy: A case report. following anterior cruciate ligament repair) Location The recognized sites of osteochondral defects are: femoral condyle (most common in the lateral aspect of the medial femoral condyle) humeral head talus capitellum of the humerus Staging Matthewson MH, Dandy DJ. Anterior cruciate ligament tear | Radiology Reference Article Shah JN, Howard JS, Flanigan DC, et al. This article reviews the mechanism, diagnosis, classification, and treatment of Hoffa fractures. Suture anchors are drilled into the posterolateral tibia to repair the meniscus to the meniscosynovial junction. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. 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. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. your express consent. 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. Osteochondral injuries of the knee in pediatric patients. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. View Large Image Download Hi-res image Download (PPT) Highlight selected keywords in the article text. In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. Suture anchor system is mostly used to repair rotator cuff and patellar tendon. Li WH, Li Y, Wang MY. In this paper, three cases of osteochondral fracture of lateral femoral condyle were treated with arthroscopic TWINFIX Ti suture anchor internal fixation, and good results were obtained. [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. 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. J Orthop Trauma 2006;20:2736. [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. patellar margin thus corresponding to impaction injuries. Some error has occurred while processing your request. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. [77]. 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. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. Introduction. Bauer KL. 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. Clinical outcomes after absorbable suture fixation of patellar, [26]. PMC Monocondylar fractures of the femur: a review of 13 patients. [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. Operative, [46]. The bone contusions on the lateral femoral condyle, lateral aspect of the tibial plateau, medial femoral condyle, and medial aspect of the tibial plateau were documented. Shah et al[19] systematically reviewed the recurrent patellar dislocation and found that the complication rate of patellar medial collateral ligament reconstruction was as high as 26.1%. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. 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. Plate fixation for Letenneur type I. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. 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. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. J Knee Surg. FIGURE 1. [5-9] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. 2013;33:5118. Three types of fracture are defined based on the coronal fracture line (Fig. Osteochondral fracture of the lateral femoral condyle is a rare injury of the knee joint, which mostly occurs in adolescence 1.In adolescence, the cartilage-bone interface is the weakest transitional area in the knee joint, and there is no obvious boundary between calcified and uncalcified cartilage 2.The biomechanical strength of immature osteochondral junction was lower than . Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. 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. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. Intra-articular dislocation of the patella with associated, [26]. doi: 10.1097/MD.0000000000032104. White EA, Matcuk GR, Schein A, et al. Radiographic appearance -. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Operative. [21,22], In some patients, a Hoffa fracture is associated with a patellar fracture. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. 1982;68:31725. Authors 3021 Tibial plateau fractures - fixation (a) Two or three lag screws may be sufficient for simple split fractures (type l), though 'b) a buttress plate ard screws may be more secure. 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. Surgically treated Hoffa Fractures with poor long-term functional results. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. [100]. The exposed fracture line is initially fixed with a k-wire and screws are placed perpendicular to the fracture surface. may email you for journal alerts and information, but is committed Impact fractures can be classified either as ductile or brittle depending on the elongation pattern that is present. J Knee Surg 2008;21:23540. Non-union coronal fracture femoral condyle, sandwich technique: a case report. [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.
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