impaction fracture lateral femoral condyle treatment

Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. Patellar dislocation with OCF in weight-bearing area of LFC is a rare injury in adolescents. HHS Vulnerability Disclosure, Help Technique of reduction and fixation of unicondylar medial, [70]. In these fractures, the popliteus tendon and the lateral head of the gastrocnemius muscle remain attached to the fragment. [79]. osteochondral impaction fracture postsurgical (e.g. 1). Unfallchirurg 2004;107:1521. 3). Chauhan A. Irreducible, incarcerated vertical dislocation of the patella into a. Background The goal of this present study was to precisely determine the dimension and location of the impaction fracture on the lateral femoral condyle in patients with an ACL rupture. 2022 Dec 16;101(50):e32104. (B) The suture of the lateral condyle of the femur is still fixed on the surface. Epub 2020 Sep 18. J Pediatr Orthop. Medicine 2022;101:50(e32104). 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. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. (C) Making a small incision on the outside of the knee joint, it is convenient to drill two 2.0mm bone channels from the distal end of the femur from the outside to the intercondylar fossa. Knee 2004;11:1257. Reconstructive osteotomy for a malunited medial. [97]. [Patella infera. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Lateral radiographs of the affected knee were inspected for a . A review of 23 patients. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. FIGURE 1. Tong W, Yang J, Xu PL, et al. The exposed fracture line is initially fixed with a k-wire and screws are placed perpendicular to the fracture surface. Plain radiograph 2018 Oct;21(5):308-310. doi: 10.1016/j.cjtee.2018.08.004. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. chauffeur fracture: intraarticular fracture involving radial styloid; Another type of distal radius fracture is the Lister's tubercle fracture. modify the keyword list to augment your search. Osteochondral injuries of the knee in pediatric patients. [76]. sharing sensitive information, make sure youre on a federal Screw insertion direction differs among operative approaches. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. government site. Nonunion of coronal shear fracture of femoral condyle. Meyer C, Enns P, Alt V, et al. Biau DJ, Schranz PJ. Sun H, He QF, Huang YG, et al. Some error has occurred while processing your request. (C) CT examination of the left knee joint: the continuity of the subarticular bone of the lateral condyle of the left femur was interrupted. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. Seeley MA, Knesek M, Vanderhave KL. [94]. Knee Surg Sports Traumatol Arthrosc. The term comminuted fracture refers to a bone that is broken in at least two places. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. Buttress plating for a rare case of comminuted medial condylar. 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). Intraoperative, [12]. 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. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. 2007 Oct;23(10):1133.e1-4. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. [21]. 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). [99]. [102]. See this image and copyright information in PMC. -. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [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. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. The patient was evaluated by the physical therapist 2 days after his injury. Knee Surg Sports Traumatol Arthrosc. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. 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. [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. Please enable scripts and reload this page. 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. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Friederichs MG, Greis PE, Burks RT. Nonunion of a. [82,83] A biomechanical study by Li et al[84] demonstrated that plates combined with screws more firmly fixed the femoral condyle, reducing the probability of fracture displacement. Rev Chir Orthop Reparatrice Appar Mot. Agarwal S, Giannoudis PV, Smith RM. [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. Please try after some time. Transverse Hoffas or deep. Please enable it to take advantage of the complete set of features! 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. 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. modify the keyword list to augment your search. Musculoskelet Surg 2012;96:4954. Introduction. [19]. The widely known Letenneur classification not only clarifies the relationships between the fracture line and ligaments and soft tissue, but also has significance for clinical treatment and prognosis. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . You will need surgery to repair your bone, and recovery can take a year or longer. Knee Surg Sports Traumatol Arthrosc. 2001;17:5425. [100]. [66]. Busam ML, Provencher MT, Bach BR. Coronal fractures of the lateral femoral condyle. MRI of osteochondral defects of the lateral, [3]. [19] Therefore, lateral condyle fracture is significantly more common than medial condyle fracture. However, some patients had suture removal during the second arthroscopy because of suture irritation. J Orthop Trauma 2002;16:17881. 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. [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. Surgically treated Hoffa Fractures with poor long-term functional results. 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. to maintaining your privacy and will not share your personal information without (C) The free edge of the anterior foot of the meniscus was rough (degree I). This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. Westmoreland GL, McLaurin TM, Hutton WC. Atesok K, Doral MN, Whipple T, et al. Federal government websites often end in .gov or .mil. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. [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. This method is also recommended for patients with osteoporosis, metaphyseal extension, or comminuted Hoffa fractures. In this paper, three cases of osteochondral fracture of lateral femoral condyle were treated with arthroscopic TWINFIX Ti suture anchor internal fixation, and good results were obtained. Knee Surg Sports Traumatol Arthrosc 2011;19:3209. [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. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. Arthrosc Tech 2015;4:e299303. Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. 2). The Authors. 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. [96,97] Thus, closed reduction is recommended when Hoffa fracture is accompanied by patella dislocation. [22]. 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 . Cheng S, Zaidi SF, Linnau KF. [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. National Library of Medicine Sahu RL, Gupta P. Operative management of, [44]. Zeebregts CJ, Zimmerman KW, ten Duis HJ. [17]. . Long term results of unicondylar fractures of the femur. YZ and YP contributed equally to this work. Shah JN, Howard JS, Flanigan DC, et al. 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. [2,77] The heads of screws placed through the articular cartilage are countersunk to prevent damage to the cartilage. Li ZX, Song HH, Wang Q, et al. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. Postoperative reexamination of computed tomography scan showed that the bone block was well reduced. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. 2013;185:61120. Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. [105]. J Knee Surg 2008;21:23540. Goel A, Sabat D, Agrawal P. Arthroscopic-assisted fixation of, [13]. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. Gesslein M, Merkl C, Bail HJ, et al. [19]. may email you for journal alerts and information, but is committed The knee joint is placed in flexion during surgery,[65,66] placing the joint capsule and gastrocnemius in a relaxed state, which reduces the traction on the fracture and is conducive to fracture repair. 2020 The Authors. Zhao LL, Tong PJ, Xiao LW. Arthroscopy-assisted fracture fixation. Braune C, Rehart S, Kerschbaumer F, Jger A. 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. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors. [4]. Osteochondral injury after acute patellar dislocation in children and adolescents. [39]. 1982;68:31725. Injury, 2005, 36: 862865. 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. J Clin Orthop Trauma 2014;5:3841. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. Int Orthop. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. Comminuted fractures are caused by severe traumas like car accidents. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. Ercin E, Baca E, Kural C. Arthroscopic. [18]. FIGURE 2. Li et al[25] used absorbable suture to treat OCF caused by patellar dislocation and achieved good medium-term results. [65]. Jabalameli M, Bagherifard A, Hadi H, et al. Complications of anterior cruciate ligament reconstruction with bone-patellar tendon-bone constructs: care and prevention. [16]. Cruciate fracture of the distal femur: the double. 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. Wolters Kluwer Health [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. The goals of treatment include restoration of function and esthetics. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. Mashoof AA, Scholl MD, Lahav A, et al. Autologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions. On lateral radiographs, the normal femoral condyles overlap, and bone cortex interruption may not be visible. Am J Sports Med. [34] The clinical diagnosis of a Hoffa fracture relies on trauma history, physical examination, imaging, and other objective indicators as well as increased suspicion based on the history and positive signs.[35,36]. Bicondylar. 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. The https:// ensures that you are connecting to the Smith EJ, Crichlow TP, Roberts PH. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. Potini VC, Gehrmann RM. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. Hoffa's fractures. [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. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. Sharath RK, Gadi D, Grover A, et al. [16]. [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. 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. Ann Chir 1978;32:2139. This method is beneficial for reducing small and rotating fragments. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. [78]. For bicondylar fractures, a median parapatellar incision can be used. After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. [27]. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. Medicine101(50):e32104, December 16, 2022. Gao M, Tao J, Zhou Z, et al. [10]. [93]. At present, open reduction is often used to treat osteochondral fractures. Redislocation in 37/75 patients followed for 6-24 years. Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. Vaishya R, Singh AP, Dar IT, et al. Lal H, Bansal P, Khare R, et al. Disclaimer. [43]. 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. doi: 10.1016/j.arthro.2006.11.029. Ostermann PA, Neumann K, Ekkernkamp A, et al. (LTC, Lateral Tibial Condyle.) You may search for similar articles that contain these same keywords or you may A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Zhou, Yabin MDa,b; Pan, Ying MDc; Wang, Qingxian MDa; Hou, Zhiyong MDa; Chen, Wei MDa,, aDepartment of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Orthopedic Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, bDepartment of Orthopedic Surgery, Shijiazhuang The Third Hospital. Unicondylar femoral fractures: therapeutic strategy and long-term results. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. Caton J, Deschamps G, Chambat P, et al. Oral application of Qiangguyin Keli and alendronate sodium vitamin D3 tablets in postoperative anti-osteoporosis. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. Moreover, the placement of a posterior antiglide plate with screws strips more soft tissue, especially the insertion of the gastrocnemius heads, and may destroy the blood supply to the fragments. [75]. Bethesda, MD 20894, Web Policies 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 III is an oblique fracture of the femoral condyle with the fracture line located anterior to the joint capsule, anterior cruciate ligament, lateral collateral ligament, popliteal tendon, and the lateral head of the gastrocnemius muscle. Analysis of functional outcome of Hoffa fractures: a retrospective review of 32 patients. A rare case of bicondylar. Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. [91]. Materials and methods: This HIPAA-compliant retrospective study was approved by our Institutional Review Board. 4). Life (Basel). Lian X, Zeng YJ. [98]. Soft tissues are retracted to . Intra-articular dislocation of the patella. 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.. 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 case report. Jain A, Agrawal P, Chadha M, et al. An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. 1). Hoffa fragment associated with a femoral shaft fracture. 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. Medicine (Baltimore). [21]. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. [51]. [30]. 2013;37:238594. Epub 2022 Nov 15. [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. patellar margin thus corresponding to impaction injuries. Arthroscopy 2011;27:81724. [74]. The patellar height was in the normal range (Caton-Deschamp index 1.0). Iwai T, Hamada M, Miyama T, et al. Callewier A, Monsaert A, Lamraski G. Lateral. Difficulties involved in the Hoffa fractures [in German]. White EA, Matcuk GR, Schein A, et al. [10] Some of these patients may have a history of poliomyelitis that predisposes individuals to osteoporosis. 2018;31:38291. Twenty-seven-year nonunion of a. Lateral-view radiograph of the left knee demonstrating an abnormally deep depression of the medial condylopatellar sulcus (arrow). [13] There are also many reports on OCF in non-weight-bearing area of LFC. Tan Y, Li H, Zheng Q, et al. Data is temporarily unavailable. Search for Similar Articles The specific mechanism of a Hoffa fracture is not well understood. J Orthop Trauma 1999;13:13840. Other structures may be fractured at the same time due to the great forces experienced through the femur bones. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. Internal fixation with lag screws plus an antigliding plate for the, [88]. Arthroscopy. If fractures are present they are usually associated with orbital rim or other significant craniofacial injuries.
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