[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. 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. 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. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. Operative, [46]. Surgical treatment of femoral medial condyle fracture with lag screws Treatment and prognosis. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. [9]. [98]. Two cartilage masses can be seen during the operation. Zeebregts CJ, Zimmerman KW, ten Duis HJ. The patient felt pain in his right knee and limited movement. [22]. 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 . According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. Jabalameli M, Bagherifard A, Hadi H, et al. [29]. Wolters Kluwer Health ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. [19]. What is an Impact Fracture? - Definition from Corrosionpedia [11,12] The bone marrow edema at the posterolateral aspect of the LFC suggest that the knee joint is highly flexed during patellar dislocation. 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. Coronal fractures of the lateral femoral condyle. Distal Femur Fractures - Trauma - Orthobullets Federal government websites often end in .gov or .mil. [31]. Intra-articular dislocation of the patella. [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. Arthroscopy. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. Osteochondral fractures of the lateral, [11]. Dhillon MS, Mootha AK, Bali K, et al. Hoffa's fractures. Atesok K, Doral MN, Whipple T, et al. Int Orthop. Soft tissues are retracted to . MRI of osteochondral defects of the lateral, [3]. Published by Wolters Kluwer Health, Inc. Arthroscopy 1996;12:2247. Med Sci Monit, 2012, 18: CS117CS120. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. (B) The sutures passing through the bone canal and the corresponding sutures on the anchor were tightened and fixed. Wagih AM. 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 . 2018;31:38291. Starr AJ, Jones AL, Reinert CM. For simple lateral condylar Hoffa fractures, a patellar anterolateral approach is most commonly used. Arthroscopic. [84]. 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. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. An impact fracture is a form of failure where a metal separates into fragments due to a stress applied at a temperature below the metal's melting point. Making the diagnosis of a Hoffa fracture is challenging. In addition to changes in bone mineral composition and a reduced proportion of bone matrix in patients with osteoporosis, changes in bone microstructure, thinning of bone cortex, and reduction in the number and size of bone trabeculae result in a decreased bone load capacity[26] and an increased risk of a Hoffa fracture with low-energy trauma. Epub 2007 Mar 23. Gesslein M, Merkl C, Bail HJ, et al. Please enable it to take advantage of the complete set of features! 2020 Jun 15;9 (6):e823-e828. [21]. [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. The patient was evaluated by the physical therapist 2 days after his injury. Shah JN, Howard JS, Flanigan DC, et al. Intertrochanteric Fractures of the Femur | SpringerLink The natural history. Complications of humerus fracture treatment. 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. Injury 2018;49:398403. Long term results of unicondylar fractures of the femur. [9]. [7]. Buttress plating for a rare case of comminuted medial condylar. [66]. We report a case of patellar dislocation with OCF in the weight-bearing area of LFC. http://creativecommons.org/licenses/by-nc-nd/4.0. Ji G, Wang S, Wang X, et al. Report of 20 cases [in French]. [72]. [102]. Ostermann PA, Neumann K, Ekkernkamp A, et al. [58]. [105]. At present, open reduction is often used to treat osteochondral fractures. Khle J, Angele P, Balcarek P, et al. [16]. Nonunion of coronal shear fracture of femoral condyle. absorbable internal fixation; dislocation of patella; femoral condyle; osteochondral fracture. Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fractures--a prospective review of 18 patients. J Orthop Trauma 1999;13:13840. Iwai T, Hamada M, Miyama T, et al. Intra-articular corrective osteotomy for malunited. 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. Matthewson MH, Dandy DJ. J Bone Joint Surg Am 2006;88:22704. 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. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. Valgus strain on the knee and the continuous pull of the quadriceps causes the patella to ride against the femoral condyle, resulting in rotation around its vertical axis. J Orthop Surg 2017;25:17. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. Please try again soon. [57]. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. your express consent. Fracture and dislocation compendium: Orthopaedic Trauma Association Committee for Coding and, [35]. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. An unusual fracture of the lateral femoral condyle in a child. Impaction Fracture of the Medial Femoral Condyle An official website of the United States government. (LTC, Lateral Tibial Condyle.) 2021;13(1_suppl):966S73S. [91]. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. [97]. Bali K, Mootha AK, Krishnan V, et al. Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro. The site is secure. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. Segmentation of the lateral femoral notch sign with MRI using a new sharing sensitive information, make sure youre on a federal Int Orthop 2015;39:124550. doi: 10.1097/MD.0000000000032104. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. FIGURE 1. Osteochondral fracture (OCF) in weight-bearing area of lateral femoral condyle (LFC) is a rare combined injury caused by patellar dislocation. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. J Orthop Trauma 1994;8:1426. Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. View Large Image Download Hi-res image Download (PPT) Bicondylar. Am J Sports Med. After arthroscopic confirmation of Lateral Femoral Condyle (LFC) ostechondral fracture (HSL, Hill-Sachs-like Lesion) the anterolateral portal is enlarged to 2-3 cm. The work cannot be changed in any way or used commercially without permission from the journal. [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. 2007;41 Suppl 2:105-12. Xray examination of right knee joint: free bone mass can be seen at the anterior edge of the femur in the knee joint. Analysis of functional outcome of Hoffa fractures: a retrospective review of 32 patients. Tsai CH, Hsu CJ, Hung CH, et al. Chauhan A. Irreducible, incarcerated vertical dislocation of the patella into a. A biomechanical study[5] shown that several smaller-diameter screws cause less damage to the joint cartilage than larger-diameter screws but that both have the same tensile force. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. 8600 Rockville Pike Transverse Hoffas or deep. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). Data is temporarily unavailable. At present, open reduction is often used to treat osteochondral fractures. An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. patellar margin thus corresponding to impaction injuries. The Authors. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. Sasidharan B, Shetty S, Philip S, et al. 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. The injury to MCL was also observed with MRI. [95]. Surgically treated Hoffa Fractures with poor long-term functional results. 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. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. Federlin M, Krifka S, Herpich M, et al. [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. Frangakis EK. Sharath RK, Gadi D, Grover A, et al. [100]. Femoral Condyle Fractures are a painful condition which can result from trauma injuries to the thigh bone and/or knee. [10]. Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. This site needs JavaScript to work properly. J Clin Orthop Trauma 2014;5:3841. In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. Cartilage. Jarit GJ, Kummer FJ, Gibber MJ, et al. Somford MP, van Ooij B, Schafroth MU, et al. Injury 2015;46:41921. Osteochondral injury after acute patellar dislocation in children and adolescents.

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