The patient was evaluated by the physical therapist 2 days after his injury. patellar margin thus corresponding to impaction injuries. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. -, Patel JM, Saleh KS, Burdick JA, Mauck RL. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. Lateral radiographs of the affected knee were inspected for a . CT examination 6months after operation: one screw internal fixation, regular external condyle cortex, good alignment at the end of fracture, callus growth and unclear fracture line could be seen in the right lateral femoral condyle. [99]. Hoffa nonunion, two cases treated with headless compression screws. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with government site. 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. Subchondral Impaction Fractures of the Medial Femoral Condyle in - LWW Tripathy SK, Aggarwal A, Patel S, et al. 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. [31]. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. Lewis SL, Pozo JL, Muirhead-Allwood WF. [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. Primary traumatic patellar dislocation. [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. Difficulties involved in the Hoffa fractures [in German]. [2,77] The heads of screws placed through the articular cartilage are countersunk to prevent damage to the cartilage. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. 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.. According to the internal fixation principle, the antiglide plate should be fixed in the posterior position. 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). 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. 2001;17:5425. [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. [96]. 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. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. Chin J Traumatol 2011;14:1436. [48]. Careful consideration and attention to the principles of fracture management, and the role of the condyle as an articulating . 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. to maintaining your privacy and will not share your personal information without Hoffa's fractures. [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. Medicine 2022;101:50(e32104). Baker BJ, Escobedo EM, Nork SE, et al. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. Biau DJ, Schranz PJ. [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. Low-energy trauma can cause Hoffa fractures in people with skeletal immaturity[24] as well as in those with low bone mass, such as patients with osteoporosis. Search for Similar Articles Hoffa fractures are caused by shear stress between the femoral condyle and tibial plateau. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. 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. 4). avulsion fracture of the anterior cruciate ligament attachment to the -. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. A rare case of unicondylar medial, [24]. The .gov means its official. Impact fractures are due to track formation and propagation. [9]. [1]. [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. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. Published by Wolters Kluwer Health, Inc. [103]. In the AO classification, Hoffa fracture is classified as type B3.2. Soraganvi PC, Narayan Gowda B, Rajagopalakrishnan R, et al. At present, open reduction is often used to treat osteochondral fractures. -, Morris John K, Weber Alexander E, Morris Mark S. Adolescent femoral chondral fragment fixation with polyLlactic acid chondral darts. [97]. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. Open bicondylar, [23]. A case of distal femur medial condyle Hoffa type II(C) fracture treated with headless screws. Biau DJ, Schranz PJ. 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. [17]. may email you for journal alerts and information, but is committed Singh AP, Dhammi IK, Vaishya R, et al. Bilateral. Unfallchirurg 2004;107:1521. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. Humerus Fracture: Types, Symptoms & Treatment - Cleveland Clinic Intra-articular corrective osteotomy for malunited. [8]. Coronal plane fracture of the femoral condyles: anatomy, injury patterns, and approach to management of the Hoffa fragment. Lee SY, Niikura T, Iwakura T, et al. [105]. [57]. Impaction fracture of the medial femoral condyle - PubMed classification; diagnosis; Hoffa fracture; injury mechanism; treatment. 2012;40:191623. Egol KA, Broder K, Fisher N, et al. 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 Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. Marzouki A, Zizah S, Benabid M, et al. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. doi: 10.1016/j.eats.2020.02.016. 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. J Bone Joint Surg Br 1989;71:11820. Some error has occurred while processing your request. 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. (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. Impact fractures can be classified either as ductile or brittle depending on the elongation pattern that is present. Medial and lateral buttressing may be required if either fracture extends proximally in the same plane. FIGURE 1. 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. Ji G, Wang S, Wang X, et al. Sun H, He QF, Huang YG, et al. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. You may search for similar articles that contain these same keywords or you may Bone contusion and associated meniscal and medial collateral - PubMed Rue JP, Busam ML, Detterline AJ, et al. [19] Therefore, lateral condyle fracture is significantly more common than medial condyle fracture. Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. [96,97] Thus, closed reduction is recommended when Hoffa fracture is accompanied by patella dislocation. However, the latest biomechanical study[88] showed that lateral antiglide plate has greater anti-shearing strength than posterior fixation. Keyword Highlighting Knee Surg Sports Traumatol Arthrosc. J Knee Surg. The patient was referred to an or- thopaedic surgeon, who recommended conservative management. [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. Distal femur fractures most often occur either in older people whose bones . Please try after some time. A patient, 15-year-old, female student. Technique for Treatment of Subchondral Compression Fracture of the Lateral Femoral Condyle Associated With ACL Tear Technique for Treatment of Subchondral Compression Fracture of the Lateral Femoral Condyle Associated With ACL Tear Arthrosc Tech. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. Surgical versus nonsurgical treatments of acute primary patellar dislocation with special emphasis on the MPFL injury patterns. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. FIGURE 2. Ann Chir 1978;32:2139. Comminuted fractures are caused by severe traumas like car accidents. The swashbuckler: a modified anterior approach for fractures of the distal femur. Transverse Hoffa's or deep osteochondral fracture? Medicine (Baltimore). The treatment options for OCF of LFC include: loose body removal, microfracture, open reduction and internal fixation, cartilage transplantation, autologous or allogeneic osteochondral transplantation, etc. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Highlight selected keywords in the article text. [92]. Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. Subchondral insufficiency fracture of the knee: a non-traumatic injury [33] Dua and Shamshery[34] proposed a classification method that supplements the AO classification with proper surgical planning to optimize outcomes. [47]. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. For bicondylar fractures, a median parapatellar incision can be used. Postoperative reexamination of computed tomography scan showed that the bone block was well reduced. [15]. Friederichs MG, Greis PE, Burks RT. McDonough PW, Bernstein RM. Mashoof AA, Scholl MD, Lahav A, et al. 1986;14:11720. doi: 10.1097/MD.0000000000032104. J Bone Joint Surg Am 1974;56:4234. Radiographs of knee joint show loose body in joint. Gesslein M, Merkl C, Bail HJ, et al. Acta Orthop Scand 1997;68:4246. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. 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. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. The natural history. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. Refixation of large osteochondral fractures after patella dislocation shows better mid- to long-term outcome compared with debridement. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. Ercin E, Baca E, Kural C. Arthroscopic. 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. Allmann KH, Altehoefer C, Wildanger G, et al. Skeletal Radiol 2015;44:3743. femoral shaft fracture presentation 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. 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.
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