impaction fracture lateral femoral condyle treatment

During the operation, we found that 2.5*2. Transverse Hoffas or deep. Lateral radiographs of the affected knee were inspected for a . Long term results of unicondylar fractures of the femur. J Bone Joint Surg Am 2006;88:22704. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. Knee 2004;11:1257. [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. Preliminary X-ray examination showed osteochondral defects of LFC and loose body in knee joint (Fig. 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 . Published by Wolters Kluwer Health, Inc. Li ZX, Song HH, Wang Q, et al. J Orthop Trauma 1999;13:13840. Ostermann PA, Neumann K, Ekkernkamp A, et al. Sanders TG, Paruchuri NB, Zlatkin MB. The patient's treatment plan included 6 weeks of weight bearing as tolerated for the left lower extremity while wearing a knee brace that prevented the final 20 of knee extension, and a program of range-of-motion and progressive resistive exercises, with eventual emphasis on sport-specific activities. J Orthop Trauma 1994;8:1426. [105]. Shah JN, Howard JS, Flanigan DC, et al. If fractures are present they are usually associated with orbital rim or other significant craniofacial injuries. In the AO classification, Hoffa fracture is classified as type B3.2. [30]. Recurrence after patellar dislocation. Life (Basel). Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. Lian X, Zeng YJ. Distal femur fractures most often occur either in older people whose bones . Am J Sports Med. Some error has occurred while processing your request. 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. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. [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. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. Bioactive factors for cartilage repair and regeneration: improving delivery, retention, and activity. Monocondylar fractures of the femur: a review of 13 patients. Keyword Highlighting AIMER was located at the outlet of the medial bone canal of the lateral condyle of the femur, and the HANDLE was adjusted to a suitable angle (5060). Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. Buttress plating for a rare case of comminuted medial condylar. [21]. ;Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. During the operation, 2 4.5mm anchor (Smith @ nephew TIWNFIX Ultra PK Suture Anchor) was inserted into the posterior edge and medial edge of the cartilage mass in the weight-bearing area, and then 2 non-absorbable sutures on each anchor were replaced by an absorbable suture (ETHICON VICRYL PLUS VCP359H), and finally the 2 ends of the absorbable suture were knotted to prevent sliding. Arthroscopy 2011;27:81724. Some error has occurred while processing your request. After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. [91]. J Orthop Trauma 2002;16:17881. [13] There are also many reports on OCF in non-weight-bearing area of LFC. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [101]. Intraoperative, [12]. Please try again soon. Suture anchors are drilled into the posterolateral tibia to repair the meniscus to the meniscosynovial junction. J Surg Case Rep 2012;2012:10. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). may email you for journal alerts and information, but is committed 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. (B) The suture of the lateral condyle of the femur is still fixed on the surface. Visual observation revealed significant right knee effusion and an inability to bear weight on the right lower extremity or flex his knee beyond 80. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. J Orthop Surg 2017;25:17. [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. J Bone Joint Surg Br 1989;71:11820. The most common way to fracture the femoral condyles is jumping from a large height. Screw insertion direction differs among operative approaches. The patient was evaluated by the physical therapist 2 days after his injury. Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. [17]. An official website of the United States government. 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. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. [15]. 1). Please try again soon. Osteochondral fractures of the lateral. The specific mechanism of a Hoffa fracture is not well understood. After hospitalization, the patients underwent computed tomography scan and magnetic resonance examination. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. Please enable it to take advantage of the complete set of features! [53]. [72]. You may search for similar articles that contain these same keywords or you may . Acute patellar dislocation in children and adolescents: a randomized clinical trial. [2] This fracture type was 1st described by Busch in 1869. 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. Fracture and dislocation compendium: Orthopaedic Trauma Association Committee for Coding and, [35]. Pathology. Biau DJ, Schranz PJ. Jabalameli M, Bagherifard A, Hadi H, et al. and transmitted securely. Cruciate fracture of the distal femur: the double. Intertrochanteric femoral fractures account for 3.13% of total adult fractures, 24.56% of femoral fractures, and 50% of proximal femoral fractures (Koval et al. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. -, Morris John K, Weber Alexander E, Morris Mark S. Adolescent femoral chondral fragment fixation with polyLlactic acid chondral darts. Posterior wall blowout in anterior cruciate ligament reconstruction: avoidance, recognition, and salvage. In reviewing left knee radiographs that had previously been interpreted as normal, the physical therapist noted an abnormally deep depression of the medial condylopatellar sulcus, which was concerning for a possible impacted osteochondral fracture. 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. 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. Am J Sports Med 2008;36:37994. [Treatment of extensive chondral defects of the patella after patellar dislocation]. 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. Disclaimer. Difficulties involved in the Hoffa fractures [in German]. Musculoskelet Surg 2012;96:4954. Introduction. J Bone Joint Surg Am 2008;90:46370. Hingelbaum S, Best R, Huth J, et al. [66]. Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. 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. For example, a fracture line dividing the femoral condyle surface into 2 parts is classified as type I; 2 fracture lines dividing the femoral condyle surface into 3 parts is type II; and 3 or more fracture lines dividing the femoral condyle surface into 4 or more parts is type III. Comminuted fractures are caused by severe traumas like car accidents. Akan K, Akgun U, Poyanli O, et al. [97]. The distal femur is where the bone flares out like an upside-down funnel. Neglected. Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. Acta Orthop Scand 1997;68:4246. your express consent. Knee Surg Sports Traumatol Arthrosc. 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.) This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). [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. The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request. A fracture is a broken bone. Bauer KL. Intra-articular dislocation of the patella. Please enable scripts and reload this page. Vaishya R, Singh AP, Dar IT, et al. J Knee Surg. Atesok K, Doral MN, Whipple T, et al. 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. 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. Keyword Highlighting [82]. normal vital signs. 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. Allmann KH, Altehoefer C, Wildanger G, et al. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. This sign represents a severe bone contusion caused by impression, and microfracturing, visible on MRI, and is suspect for an impacted (osteo)chondral fracture due to a tear of . 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. Biau DJ, Schranz PJ. Lateral-view radiograph of the left knee demonstrating an abnormally deep depression of the medial condylopatellar sulcus (arrow). A review of 23 patients. Bicondylar. (A) The fresh 1.5cm1.5cm fracture surface of the lateral condyle of femur was found under arthroscopy. You will need surgery to repair your bone, and recovery can take a year or longer. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. [3,4] In 1888, Hoffa described coronal fracture of the femoral condyle but did not indicate the source of the previous reference. Intra-articular corrective osteotomy for malunited. [10] Werner and Miller [11] reported that iatrogenic injury is a cause of Hoffa fracture . This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. J Pediatr Orthop B, 2013, 22: 344349. In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. [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. Would you like email updates of new search results? A rare case of bicondylar. [21]. Ul Haq R, Modi P, Dhammi I, et al. Epub 2020 Sep 18. 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. [76]. Distal pulses and sensation were intact. In general, there has been a trend toward . Chin J Traumatol. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. [20]. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. The site is secure. Goel A, Sabat D, Agrawal P. Arthroscopic-assisted fixation of, [13]. National Library of Medicine [64] Open reduction and internal fixation is the 1st choice for the treatment of displaced Hoffa fractures, and it is also suitable for the treatment of nondisplaced Hoffa fractures. [36]. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. 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 . Complications of anterior cruciate ligament reconstruction with bone-patellar tendon-bone constructs: care and prevention. Meta plate and cannulated screw fixation for, [86]. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Callewier A, Monsaert A, Lamraski G. Lateral. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. 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. Arthroscopy. 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. Arastu MH, Kokke MC, Duffy PJ, et al. Nonunion of coronal shear fracture of femoral condyle. [31]. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. Xu Y, Li H, Yang HH, et al. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. Springerplus 2016;5:1164. [22]. Lal H, Bansal P, Khare R, et al. Two cartilage masses can be seen during the operation. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. Type 2 fractures require a . Injury 2018;49:398403. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Arthroscopy 1996;12:2247. Gao M, Tao J, Zhou Z, et al. [90]. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). [96]. [56]. Fixation with headless screws can reduce the degree of cartilage injury. Antigliding plating for Letenneur type I Hoffa fractures. [24]. [7]. The patient felt pain in his right knee and limited movement. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. [21] Matthewson et al[21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early internal fixation and external fixation to avoid early weight bearing, and achieved good results. [40]. 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. An unusual fracture of the lateral femoral condyle in a child. The incidence ratio in male and female patients is in the range . Before Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. [18]. patellar margin thus corresponding to impaction injuries. 2020 The Authors. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. 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 Dhillon MS, Mootha AK, Bali K, et al. Repair of displaced partial articular fracture of the distal femur: the. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . 5 and 6), and the lysholm score was 95 points, which was very good. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. Knee Surg Sports Traumatol Arthrosc. Operative, [46]. [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. For tibial fractures, the use of bone plates or intramedullary nails is recommended if the condition of the local soft tissue is suitable. Types I and III Hoffa fractures usually have a good prognosis because the soft tissue remains attached to the fragment, ensuring an adequate blood supply. A lateral incision plus Gerdy tubercle osteotomy provides full exposure[68] especially in cases of coronal fracture of the lateral condyle. Nork SE, Segina DN, Aflatoon K, et al. Orthopedics, 2016, 39: e362e366. Epub 2022 Nov 15. Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fractures--a prospective review of 18 patients. A rare case of unicondylar medial, [24]. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. Miyamoto R, Fornari E, Tejwani NC. Transverse Hoffa's or deep osteochondral fracture? At present, open reduction is often used to treat osteochondral fractures. 2007 Oct;23(10):1133.e1-4. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. Unfallchirurg 2004;107:1521. Intra-articular dislocation of the patella with associated, [26]. -. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. [9]. The https:// ensures that you are connecting to the By definition, secondary osteonecrosis of the knee occurs secondary to an insult. Li et al[25] used absorbable suture to treat OCF caused by patellar dislocation and achieved good medium-term results. 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 . 1). Therefore, further studies are needed to improve the quality of Hoffa fracture reduction under arthroscopy. Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro. Incarcerated patellar tendon in.
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