J Orthop Surg 2017;25:17. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. At present, open reduction is often used to treat osteochondral fractures. [95]. 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. Introduction. * Correspondence: Lijiang He, Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Hangzhou, Zhejiang 311121, China (e-mail: [emailprotected]). Osteochondral fractures of the lateral. The natural history. Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro. Bicondylar. Please try again soon. 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. Chin J Orthop Trauma 2009;9:8503. [25] Loss of bone matrix results in brittle, weaker bones that break rather than bend with external force. [1]. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Federlin M, Krifka S, Herpich M, et al. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. [89]. [53]. 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. Calmet J, Mellado JM, Garcia Forcada IL, et al. Lal H, Bansal P, Khare R, et al. 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%. [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. Arthroscopic-assisted fixation of. to maintaining your privacy and will not share your personal information without Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. 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.) Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. Allmann KH, Altehoefer C, Wildanger G, et al. Federal government websites often end in .gov or .mil. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Injury 2018;49:398403. Knee flexion was limited less than 60 within 8 weeks after operation, partial weight-bearing was allowed at 8 weeks, followed by full weight bearing from 12 weeks after operation. Xu Y, Li H, Yang HH, et al. This site needs JavaScript to work properly. 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. [4]. Li ZX, Song HH, Wang Q, et al. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. Arthroscopy. Egol KA, Broder K, Fisher N, et al. [1] A Hoffa fracture, a rare fracture confined to the coronal plane of either femoral condyle, accounts for 8.7% to 13% of distal femoral fractures. doi: 10.1016/j.arthro.2006.11.029. After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. We prospectively documented all potential cases of non-weight-bearing posterior subchondral impaction fractures of the femoral condyles diagnosed on magnetic resonance imaging (MRI) of the knee performed at our institution between January 2006 and December 2011. Dejour H, Walch G, Nove-Josserand L, et al. The patient was evaluated by the physical therapist 2 days after his injury. 3). Tong W, Yang J, Xu PL, et al. Osteochondral injury after acute patellar dislocation in children and adolescents. After 1 year follow-up, good functional and radiographic outcome were obtained. In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. [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. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. Recurrence after patellar dislocation. 1982;68:31725. (B) The suture of the lateral condyle of the femur is still fixed on the surface. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. 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. Bali K, Mootha AK, Krishnan V, et al. Buttress plating for a rare case of comminuted medial condylar. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. Your message has been successfully sent to your colleague. 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. 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 . [9] The pain due to these combined injuries often exceeds that caused by the Hoffa fracture, which can lead physicians to miss the latter. This method is also recommended for patients with osteoporosis, metaphyseal extension, or comminuted Hoffa fractures. Med Sci Monit, 2012, 18: CS117CS120. J Pediatr Orthop. Acta Orthop Belg 2001;67:1328. 2021 Jan 26;9(1):2325967120974649. doi: 10.1177/2325967120974649. 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. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). We replaced the anchor suture with (ETHICON VICRYL PLUS VCP 359H) suture during the operation, which is an attempt based on the research of Li,[25] in order to avoid the second operation. Bartonicek J, Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. Surgical diagrams (A: osteochondral fracture of the lateral femoral condyle; B: fixation of fracture block with Kirschner wire; C: fixation of fracture block with anchor; D: preparation of bone tunnel; E: penetration of PDS line and PDS guidance of anchor suture to the outer entrance of femoral tunnel; F: Operation completion diagram). We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. [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. 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 . 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. Marzouki A, Zizah S, Benabid M, et al. Plain radiograph A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. Careful consideration and attention to the principles of fracture management, and the role of the condyle as an articulating . Monocondylar fractures of the femur: a review of 13 patients. 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. Nakagawa S, Arai Y, Inoue H, et al. [15,1720] The fracture line its inclination angle of a Hoffa fracture depend on the degree of knee joint flexion at the time of trauma[18]; as the angle of knee flexion increases, the fracture line will occur farther from the posterior cortex of the femoral-condyle. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. Careers. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. J Pediatr Orthop B, 2013, 22: 344349. The risk of blood vessel damage when using this approach is minimal but the common peroneal nerve should be isolated first. [21]. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. Unfallchirurg 2004;107:1521. 2023 Jan;15(1):103-110. doi: 10.1111/os.13586. The white arrow indicate the defect area. [48]. Therefore, further studies are needed to improve the quality of Hoffa fracture reduction under arthroscopy. Arthroscopy 2011;27:81724. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. Bookshelf [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. Disclaimer. [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. Injury 2015;46:41921. In general, there has been a trend toward . [2]. In some cases, the Letenneur II fragment is small but essential for the knee join when flexed at 90 because it ensures the articular surface integrity. Meta plate and cannulated screw fixation for, [86]. J Bone Joint Surg Am 2005;87:5649. 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. For simple lateral condylar Hoffa fractures, a patellar anterolateral approach is most commonly used. Knee Surg Sports Traumatol Arthrosc 2011;19:3209. [10]. 2021. 2017;30:37884. Moreover, even if the medial patellar retinaculum is strengthened, the patient still has symptoms such as anterior knee pain. [82]. Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. Operative. eCollection 2021 Jan. Uimonen MM, Repo JP, Huttunen TT, Nurmi H, Mattila VM, Paloneva J. Knee Surg Sports Traumatol Arthrosc. A fracture is a broken bone. Lewis SL, Pozo JL, Muirhead-Allwood WF. 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 . Redislocation in 37/75 patients followed for 6-24 years. 2003;19:71721. [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. View Large Image Download Hi-res image Download (PPT) 1). 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. Your message has been successfully sent to your colleague. J Orthop Trauma 2002;16:17881. 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. Apropos of 128 cases]. [84]. Highlight selected keywords in the article text. Int Orthop 2015;39:124550. Sagittal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. -, Morris John K, Weber Alexander E, Morris Mark S. Adolescent femoral chondral fragment fixation with polyLlactic acid chondral darts. 1986;14:11720. Maenpaa H, Huhtala H, Lehto MU. (A) MRI examination of the right knee joint: the bone continuity at the edge of the lateral condyle of the right femur was poor, the patchy high signal intensity was seen in the bone marrow cavity of the lateral condyle of the femur, and the local cartilage became thinner in the corresponding area. [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. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. [33]. ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. 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. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. [19]. [65]. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. 2007;41 Suppl 2:105-12. Min L, Tu CQ, Wang GL, et al. Khle J, Angele P, Balcarek P, et al. [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.