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. The term comminuted fracture refers to a bone that is broken in at least two places. (A) Use of anterior cruciate ligament locator to assist drilling at the distal end of the femur. Li et al[25] used absorbable suture to treat OCF caused by patellar dislocation and achieved good medium-term results. Please try again soon. An official website of the United States government. Letenneur J, Labour PE, Rogez JM, et al. Smith EJ, Crichlow TP, Roberts PH. 2020 The Authors. 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. Redislocation in 37/75 patients followed for 6-24 years. However, if the tunnel is too close to the distal femoral articular surface and too little cartilage-covered bone is retained, either the passage of the tendon through the bone tunnel or fixation of the tendon can lead to a Hoffa fracture. For local soft-tissue injuries, external fixation can be used, but this may delay the time to mobility restoration and affect therapeutic efficacy. [103]. [5] Viskontas et al[69] reported an extensile medial subvastus approach that allows better exposure of the surgical field and protects the blood supply of the bones comparing with the medial parapatellar approach. Bali K, Mootha AK, Krishnan V, et al. This system allows the classification of comminuted femoral condyle fractures. Before [2,77] The heads of screws placed through the articular cartilage are countersunk to prevent damage to the cartilage. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. Skeletal Radiol 2015;44:3743. The injury to MCL was also observed with MRI. [65]. Gesslein M, Merkl C, Bail HJ, et al. 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. Plate fixation for Letenneur type I. 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. Injury 2015;46:41921. Knee Surg Sports Traumatol Arthrosc. Nork SE, Segina DN, Aflatoon K, et al. 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. Orthop J Sports Med. [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 systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. to maintaining your privacy and will not share your personal information without
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. Jiang YR, Wang ZY, Zhang DB, et al. 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. Arthroscopic-assisted fixation of. Conjoint bicondylar, [22]. If fractures are present they are usually associated with orbital rim or other significant craniofacial injuries. Ann Chir 1978;32:2139. your express consent. Plain radiograph One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Calmet J, Mellado JM, Garcia Forcada IL, et al. 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. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. Z Orthop Ihre Grenzgeb. Ul Haq R, Modi P, Dhammi I, et al. Fracture surgery complications include: Acute compartment syndrome (ACS): A build-up of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage. At present, open reduction is often used to treat osteochondral fractures. You may be trying to access this site from a secured browser on the server. [10]. Cruciate fracture of the distal femur: the double. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. Manfredini M, Gildone A, Ferrante R, et al. Wolters Kluwer Health
[6]. Gao et al[70] reported a medial to medial-posterior distal femur approach in which the fragments were exposed through the interval space between the gracilis muscle and medial head of the gastrocnemius and the medial collateral ligament can be clearly exposed and protected. Type 2 fractures require a . This is the first case to apply the suture anchor system to the reduction and fixation of fracture. FIGURE 1. Internal fixation with headless compression screws and back buttress plate for. Transverse Hoffa's or deep osteochondral fracture? Biau DJ, Schranz PJ. Shah JN, Howard JS, Flanigan DC, et al. In anterior cruciate ligament reconstruction, an anterior medial approach to the femoral tunnel allows restoration of the position of the tendon graft and increases rotation stability when an expanded bone tunnel is used for the graft. Tsai CH, Hsu CJ, Hung CH, et al. Zhou S, Cai M, Huang K. Treatment of. absorbable internal fixation; dislocation of patella; femoral condyle; osteochondral fracture. Authors osteochondral impaction fracture postsurgical (e.g. 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. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. 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. 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). Knee Surg Sports Traumatol Arthrosc. Refixation of large osteochondral fractures after patella dislocation shows better mid- to long-term outcome compared with debridement. 1). Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout: a cadaveric study. Agarwal S, Giannoudis PV, Smith RM. 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 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. Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. [22]. Keyword Highlighting
2018;31:38291. Heuschen UA, Gohring U, Meeder PJ. [23]. [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. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. Internal fixation with lag screws plus an antigliding plate for the, [88]. [104]. Distal femur fractures most often occur either in older people whose bones . This kind of disease is commonly seen in the knee joint sprain during strenuous activity. [58]. [10]. Reconstructive osteotomy for a malunited medial. Technique of reduction and fixation of unicondylar medial, [70]. 2003;19:71721. [5]. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Goel A, Sabat D, Agrawal P. Arthroscopic-assisted fixation of, [13]. Am J Sports Med 2008;36:37994. Making the diagnosis of a Hoffa fracture is challenging. You may search for similar articles that contain these same keywords or you may
Injury 2005;36:8625. An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Hoffa fragment associated with a femoral shaft fracture. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. (A) The fresh 1.5cm1.5cm fracture surface of the lateral condyle of femur was found under arthroscopy. Suture anchor system is mostly used to repair rotator cuff and patellar tendon. Allmann KH, Altehoefer C, Wildanger G, et al. [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. Tsai et al[103] reported that surgical treatment is the 1st choice for Hoffa fracture accompanied by traumatic patella dislocation; if conservative treatment is adopted, the redislocation rate is as high as 40%. 1996 ). [95] Because Hoffa fractures are intra-articular, the success of anatomical reduction and firm internal fixation is closely related to postoperative complications like traumatic arthritis. Highlight selected keywords in the article text. 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. Am J Sports Med. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. Please enable it to take advantage of the complete set of features! Hoffa's fractures. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. Arthroscopy 2012;28:13817. [Resorbable pin refixation of an osteochondral fracture of the lateral femoral condyle due to traumatic patellar dislocation: case management, follow-up and strategy in adolescents]. 4). Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). 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 . 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. Callewier A, Monsaert A, Lamraski G. Lateral. Hoffa fracture with cruciate ligament, lateral collateral ligament, or meniscus injuries can be treated with arthroscopic surgery,[90] which has the advantages of minimal invasion, less of an effect on blood supply, early postoperative return to functional exercise, and effective prevention of nonunion and joint stiffness. In these cases, magnetic resonance imaging (MRI) can show a lateral femoral notch sign: a depression in the lateral femoral condyle, which could indicate an ACL tear . For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. [43]. [60]. Patellar dislocation with OCF in weight-bearing area of LFC is a rare injury in adolescents. may email you for journal alerts and information, but is committed
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 Published by Wolters Kluwer Health, Inc. A review of 23 patients. Injury 2018;49:398403. Springerplus 2016;5:1164. The site is secure. lateral femoral condyle fractures in 80% Angiography indications ankle-brachial index (ABI) <0.9 obvious signs of vascular injury i.e., hard and soft signs (pulselessness, rapidly expanding hematoma, massive bleeding, etc.) [7]. Marzouki A, Zizah S, Benabid M, et al. Int Orthop. (B) BULLET fixed at the entrance of the lateral bone canal of the distal femur. Malays Orthop J 2017;11:204. Federlin M, Krifka S, Herpich M, et al. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. Open bicondylar, [23]. 2013;33:5118. Vivek T, Saubhik Da, Sahil G, et al. Braune C, Rehart S, Kerschbaumer F, Jger A. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. 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. Intertrochanteric femoral fractures occur mostly in the elderly, and the average age of onset is 66-76 years. [3]. 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. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. [14]. 3 Although the examined patients were not professional athletes, some differences between these groups are worth mentioning: in the athletes, the medial rather than the lateral condyle was Transverse Hoffa's or deep osteochondral fracture? [66]. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. 5cm cartilage mass was stripped from nonweight-bearing area of the LFC, and no osteochondral mass was found at the medial edge of patella (Fig. Chin J Orthop Trauma 2009;9:8503. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. [24]. Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. [25]. 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). Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. [18]. Viskontas DG, Nork SE, Barei DP, et al. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. Factors of patellar instability: an anatomic radiographic study. chauffeur fracture: intraarticular fracture involving radial styloid; Another type of distal radius fracture is the Lister's tubercle fracture. Would you like email updates of new search results? Life (Basel). The distal femur is the area of the leg just above the knee joint. Meyer C, Enns P, Alt V, 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).