[25]. [93]. 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. The term comminuted fracture refers to a bone that is broken in at least two places. Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. Osteochondral fractures of the lateral. In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. [19]. Cruciate fracture of the distal femur: the double. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. classification; diagnosis; Hoffa fracture; injury mechanism; treatment. Injury 2011;42:14958. 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. You may be trying to access this site from a secured browser on the server. Surgical treatment of femoral medial condyle fracture with lag screws [61]. Arthroscopy-assisted fracture fixation. Hoffa nonunion, two cases treated with headless compression screws. modify the keyword list to augment your search. Werner BC, Miller MD. Arthroscopy-assisted, [55]. Med Sci Monit, 2012, 18: CS117CS120. Osteochondral Fracture Lateral Femoral Condyle Treated with - Hindawi The distal femur is where the bone flares out like an upside-down funnel. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. eCollection 2020 Jun. Three types of fracture are defined based on the coronal fracture line (Fig. Impact fractures can be classified either as ductile or brittle depending on the elongation pattern that is present. 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. Wang JY, Liu Y, Li Y, et al. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with White EA, Matcuk GR, Schein A, et al. Acta Chir Orthop Traumatol Cech. Arthroscopic management of a posterior femoral condyle (Hoffa) fracture: surgical technique. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. Cheng S, Zaidi SF, Linnau KF. Surgical treatment of femoral medial condyle fracture with lag screws The https:// ensures that you are connecting to the For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. Hoffa's fractures. Would you like email updates of new search results? your express consent. [40]. J Knee Surg 2008;21:23540. 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. Starr AJ, Jones AL, Reinert CM. Ann Chir 1978;32:2139. Coronal fractures of the lateral femoral condyle. [22]. Disclaimer. [9]. MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence 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. We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteen-year-old male with a positive history of significant weight gain of 5 kilograms in last six months. Acta Orthop Traumatol Turc 2014;48:3837. View Large Image Download Hi-res image Download (PPT) Choudhary RK, Tice JW. Gelber PE, Erquicia J, Abat F, et al. [7]. Subchondral Impaction Fractures of the Medial Femoral Condyle in - LWW [94]. An unusual fracture of the lateral femoral condyle in a child. Wu P, WB, Kong LC, et al. [3]. At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: Reduce Pain Restore Movement Optimise Recovery What are Femoral Condyle Fractures? Two patients with osteochondral injury of the weight-bearing portion of the lateral. ;Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. In these fractures, the popliteus tendon and the lateral head of the gastrocnemius muscle remain attached to the fragment. A 15-year-old female student accidentally sprained her right knee while participating in sports activities. Gerdy's tubercle osteotomy for the, [69]. Ji G, Wang S, Wang X, et al. Sagittal, fat-suppressed, proton density-weighted magnetic resonance image of the left knee demonstrating a focal indentation of the anterior portion of the medial femoral condyle (orange arrow . [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. Surgically treated Hoffa Fractures with poor long-term functional results. Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. However, some patients had suture removal during the second arthroscopy because of suture irritation. Bethesda, MD 20894, Web Policies [2]. [75]. The tears of the lateral meniscus and medial meniscus were detected during arthroscopy. Khle J, Angele P, Balcarek P, et al. Surgical, [71]. For tibial fractures, the use of bone plates or intramedullary nails is recommended if the condition of the local soft tissue is suitable. In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. 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. [16]. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. For more information, please refer to our Privacy Policy. [1]. Impaction Fracture of the Medial Femoral Condyle Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. [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]. At present, open reduction is often used to treat osteochondral fractures. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. McDonough PW, Bernstein RM. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. [29]. This method is beneficial for reducing small and rotating fragments. Gesslein M, Merkl C, Bail HJ, et al. J Surg Case Rep 2012;2012:10. A fracture is a broken bone. [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. In general, there has been a trend toward . Intra-articular dislocation of the patella. [33]. A modified posterolateral approach for. J Pediatr Orthop B, 2013, 22: 344349. A patient, 15-year-old, female student. Viskontas DG, Nork SE, Barei DP, et al. Orbital blow-out fracture | Radiology Reference Article | Radiopaedia.org 2022 Dec 16;101(50):e32104. 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. Bicondylar. 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. Meta plate and cannulated screw fixation for, [86]. Sasidharan B, Shetty S, Philip S, et al. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. Nork SE, Segina DN, Aflatoon K, et al. 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). [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. 2020 Jun 15;9 (6):e823-e828. (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. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Epub 2022 Nov 15. In the AO classification, Hoffa fracture is classified as type B3.2. to maintaining your privacy and will not share your personal information without Distal pulses and sensation were intact. Preliminary X-ray examination showed osteochondral defects of LFC and loose body in knee joint (Fig. Osteochondral fractures of the lateral, [11]. [82,83] A biomechanical study by Li et al[84] demonstrated that plates combined with screws more firmly fixed the femoral condyle, reducing the probability of fracture displacement. Nonunion of a. Twenty-seven-year nonunion of a. The patient felt pain in his right knee and limited movement. Open bicondylar, [23]. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. Introduction. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. Impaction Fracture of the Medial Femoral Condyle 2017;84:4417. The CT classification[32] uses the anatomic femoral axis and a line parallel to the posterior cortex of the femoral condyle to divide the femoral condyle into a, b, and c regions. At present, open reduction is often used to treat osteochondral fractures. Plain radiograph Arthroscopy 2012;28:13817. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. [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. [19]. 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. A review of 23 patients. Int Orthop. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. [10]. Published by Wolters Kluwer Health, Inc. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . Bartonicek J, Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. Intertrochanteric femoral fractures occur mostly in the elderly, and the average age of onset is 66-76 years. Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. Mashoof AA, Scholl MD, Lahav A, et al. Life (Basel). Smith EJ, Crichlow TP, Roberts PH. Li et al[25] used absorbable suture to treat OCF caused by patellar dislocation and achieved good medium-term results. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. [5]. [23]. Previous article . Analysis of functional outcome of Hoffa fractures: a retrospective review of 32 patients. Suture anchor system is mostly used to repair rotator cuff and patellar tendon. Intraoperative, [12]. 1986;14:11720. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. Zhao LL, Tong PJ, Xiao LW. 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. Operative, [46]. However, Gavaskar et al[2] argued that no evidence confirms this correlation. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. Min L, Tu CQ, Wang GL, et al. Highlight selected keywords in the article text. [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. Vaishya R, Singh AP, Dar IT, et al. 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. Knee Surg Sports Traumatol Arthrosc. The functional and radiographic outcome were satisfactory at 18 months after operation. [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. Your message has been successfully sent to your colleague. Some error has occurred while processing your request. [17]. Please enable scripts and reload this page. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. [96]. Technique of reduction and fixation of unicondylar medial, [70]. 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%. normal vital signs. Other structures may be fractured at the same time due to the great forces experienced through the femur bones. Chauhan A. Irreducible, incarcerated vertical dislocation of the patella into a. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Epub 2020 Sep 18. Gao M, Tao J, Zhou Z, et al. Maenpaa H, Huhtala H, Lehto MU. [104] To prevent habitual patellar dislocation, repair of the medial retinaculum complex or a combination of lateral retinacular release[14,105] and simultaneous patellar ligament insertion on the tibial tubercle is recommended. 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. Intra-articular corrective osteotomy for malunited. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. Methods All patients with post-injury bi-plane radiographs and MRI images after sustaining a tear to the anterior cruciate ligament were included. (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. 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. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [53]. [97]. After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. [3,4] In 1888, Hoffa described coronal fracture of the femoral condyle but did not indicate the source of the previous reference. Fracture of the Lateral Femoral Condyle | Journal of Orthopaedic (A) The fresh 1.5cm1.5cm fracture surface of the lateral condyle of femur was found under arthroscopy. [58]. McCarthy JJ, Parker RD. [66]. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with 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. 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. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. [79]. [19] Therefore, lateral condyle fracture is significantly more common than medial condyle fracture. 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.