2013;33:5118. Therefore, further studies are needed to improve the quality of Hoffa fracture reduction under arthroscopy. Complications of humerus fracture treatment. may email you for journal alerts and information, but is committed 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. [96]. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. You may search for similar articles that contain these same keywords or you may Am J Sports Med 2008;36:37994. Sasidharan B, Shetty S, Philip S, et al. The most common way to fracture the femoral condyles is jumping from a large height. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. When high-energy trauma involves the distal femur, the lateral condyle is often damaged[18] before the medial condyle because of the physiologic genu valgum of the knee joint. Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. The patient was referred to an or- thopaedic surgeon, who recommended conservative management. 3). Jarit GJ, Kummer FJ, Gibber MJ, et al. [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. Sharath RK, Gadi D, Grover A, et al. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. 2022 Dec 16;101(50):e32104. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. The patient felt pain in his right knee and limited movement. Search for Similar Articles modify the keyword list to augment your search. 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. Sanders TG, Paruchuri NB, Zlatkin MB. 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. Potini VC, Gehrmann RM. [9]. You may search for similar articles that contain these same keywords or you may Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. After arthroscopic confirmation of Lateral Femoral Condyle (LFC) ostechondral fracture (HSL, Hill-Sachs-like Lesion) the anterolateral portal is enlarged to 2-3 cm. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. Osteochondral fractures of the lateral, [11]. Cartilage. Unicondylar femoral fractures: therapeutic strategy and long-term results. Agarwal S, Giannoudis PV, Smith RM. Wolters Kluwer Health [95]. [7]. Radiographic appearance In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. Coronal plane fracture of the femoral condyles: anatomy, injury patterns, and approach to management of the Hoffa fragment. Highlight selected keywords in the article text. Two patients with osteochondral injury of the weight-bearing portion of the lateral. 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. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. After 1 year follow-up, good functional and radiographic outcome were obtained. Wolters Kluwer Health The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. Injury 2015;46:41921. Medicine (Baltimore). [105]. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. Arthroscopy 2012;28:13817. Braune C, Rehart S, Kerschbaumer F, Jger A. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). Making the diagnosis of a Hoffa fracture is challenging. Zhao LL, Tong PJ, Xiao LW. We report a case of patellar dislocation with OCF in the weight-bearing area of LFC. Epub 2022 Nov 15. [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. Reconstructive osteotomy for a malunited medial. Pa a et al[17] reported that 10 patients with patellar osteochondral mass less than 2.7mm2 caused by patellar dislocation still achieved good function only by taking out the loose body, and no patellar dislocation was found. Federlin M, Krifka S, Herpich M, et al. The white arrow indicate the defect area. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. Letenneur J, Labour PE, Rogez JM, et al. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. [10] Werner and Miller [11] reported that iatrogenic injury is a cause of Hoffa fracture . Other structures may be fractured at the same time due to the great forces experienced through the femur bones. Would you like email updates of new search results? Malays Orthop J 2017;11:204. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. However, some patients had suture removal during the second arthroscopy because of suture irritation. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. [16]. 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 . Transverse Hoffas or deep. Highlight selected keywords in the article text. [97]. This article reviews the mechanism, diagnosis, classification, and treatment of Hoffa fractures. Buttress plating for a rare case of comminuted medial condylar. Injury 2018;49:398403. (C) The free edge of the anterior foot of the meniscus was rough (degree I). 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. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. J Bone Joint Surg Am 2006;88:22704. 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. 2003;19:71721. When the patient has patellar dislocation with OCF in the weight-bearing area of LFC, surgical treatment and internal fixation is the treatment of choice if the OCF can be fixed. View Large Image Download Hi-res image Download (PPT) At present, open reduction is often used to treat osteochondral fractures. 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. (A) One 1.5mm Kirschner wire temporarily fixed the fracture block of the lateral condyle of the femur. [11,12] The bone marrow edema at the posterolateral aspect of the LFC suggest that the knee joint is highly flexed during patellar dislocation. Acta Orthop Scand 1997;68:4246. Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. Li ZX, Song HH, Wang Q, et al. Conjoint bicondylar, [22]. A 15-year-old female student accidentally sprained her right knee while participating in sports activities. [4]. Epub 2007 Mar 23. 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 rare case of unicondylar medial, [24]. McCarthy JJ, Parker RD. Some error has occurred while processing your request. Nonunion of coronal shear fracture of femoral condyle. [99]. Objective: To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. classification; diagnosis; Hoffa fracture; injury mechanism; treatment. The specific mechanism of a Hoffa fracture is not well understood. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). to maintaining your privacy and will not share your personal information without Coronal fractures of the lateral femoral condyle. Operative. J Pediatr Orthop. Unable to load your collection due to an error, Unable to load your delegates due to an error. [58]. Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. (C) CT examination of the left knee joint: the continuity of the subarticular bone of the lateral condyle of the left femur was interrupted. Repair of displaced partial articular fracture of the distal femur: the. d Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Zhejiang, China. Unfallchirurg 2004;107:1521. This is the first report on a fracture of medial femoral condyle treated with this implant. 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. 5 and 6), and the lysholm score was 95 points, which was very good. (B) The sutures passing through the bone canal and the corresponding sutures on the anchor were tightened and fixed. Acta Biomater, 2019, 93:222238. 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. [25] A cannulated screw combined with a plate is recommended in these cases. Analysis of functional outcome of Hoffa fractures: a retrospective review of 32 patients. Xu Y, Li H, Yang HH, et al. [ 21] Matthewson et al [ 21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early The exposed fracture line is initially fixed with a k-wire and screws are placed perpendicular to the fracture surface. (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. Emerg Radiol 2015;22:3378. [73] This approach is suitable for the treatment of Hoffa fracture with patella 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. [21]. A comparison of the clinical effect of two fixation methods on Hoffa fractures. Appointments 216.444.2606. [43]. Knee Surg Sports Traumatol Arthrosc. 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. On lateral radiographs, the normal femoral condyles overlap, and bone cortex interruption may not be visible. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. [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. Arthroscopy. Arthroscopy. Jabalameli M, Bagherifard A, Hadi H, et al. [92]. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. Arthroscopy-assisted fracture fixation. 2007;41 Suppl 2:105-12. Among the various types of Hoffa fractures, the Letenneur II is unique because the fragments are small and difficult to fix, and poor blood supply to the fragments impairs its healing. [7]. [2]. Apropos of 128 cases]. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. At present, open reduction is often used to treat osteochondral fractures. 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. Allmann KH, Altehoefer C, Wildanger G, et al. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. 2017;30:37884. Some error has occurred while processing your request. Ostermann PA, Neumann K, Ekkernkamp A, et al. Internal fixation with headless compression screws and back buttress plate for. Radiographs of knee joint show loose body in joint. Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. Mashoof AA, Scholl MD, Lahav A, et al. Technique of reduction and fixation of unicondylar medial, [70]. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. Ercin E, Baca E, Kural C. Arthroscopic. [83]. Hoffa fractures are caused by shear stress between the femoral condyle and tibial plateau.
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