(A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Iwai T, Hamada M, Miyama T, et al. Lateral Femoral Condyle (LFC) osteochondral fracture (HSL, Hill-Sachs-like Lesion) can be seen in 30 of knee flexion. [14,15] Diederichs et al[16] suggest that a first patellar dislocation is often treated conservatively, and loose body removal, microfracture and internal fixation should be selected according to the size and location of osteochondral block. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. 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. After hospitalization, the patients underwent computed tomography scan and magnetic resonance examination. Bookshelf 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. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. Nakagawa S, Arai Y, Inoue H, et al. A hip fracture is a break that occurs in the upper part of the femur (thigh bone). [4]. Knee Surg Sports Traumatol Arthrosc. According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence You may search for similar articles that contain these same keywords or you may Ostermann PA, Neumann K, Ekkernkamp A, et al. 2020 The Authors. J Orthop Trauma 2002;16:17881. 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. [2,77] The heads of screws placed through the articular cartilage are countersunk to prevent damage to the cartilage. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. [5]. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. classification; diagnosis; Hoffa fracture; injury mechanism; treatment. Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. 2017;84:4417. Twenty-seven-year nonunion of a. [82]. Previous article . Suture anchors are drilled into the posterolateral tibia to repair the meniscus to the meniscosynovial junction. Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. [100]. Zhao LL, Tong PJ, Xiao LW. Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. Rue JP, Busam ML, Detterline AJ, et al. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. Knee Surg Sports Traumatol Arthrosc 2011;19:3209. Smith EJ, Crichlow TP, Roberts PH. During the operation, we found that 2.5*2. 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. 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. Anterior cruciate ligament tear | Radiology Reference Article The .gov means its official. Akan K, Akgun U, Poyanli O, et al. J Knee Surg. Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. 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. Medicine101(50):e32104, December 16, 2022. Efficacy of multiple Acutrak hollow head compression screws in the, [68]. Internal fixation with headless compression screws and back buttress plate for. The specific mechanism of a Hoffa fracture is not well understood. The main cause of a Hoffa fracture is a high-energy injury such as those sustained in traffic collisions (80.5% of cases) and falls (9.1% of cases). 2013;33:5118. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with An official website of the United States government. Starr AJ, Jones AL, Reinert CM. (PDF) Technique for Treatment of Subchondral Compression Fracture of 1). Conjoint bicondylar, [22]. [57]. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. [42] Compared with anteroposterior and lateral films, oblique radiographic views can show minimally displaced fractures better[14] and can, therefore, be used as a routine examination method for a Hoffa fracture. Tan Y, Li H, Zheng Q, et al. The bone mass is missing at the fracture. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. 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. Preliminary X-ray examination showed osteochondral defects of LFC and loose body in knee joint (Fig. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. [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. [5-9] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Zeebregts CJ, Zimmerman KW, ten Duis HJ. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Complications of humerus fracture treatment. Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. Surgically treated Hoffa Fractures with poor long-term functional results. However, some patients had suture removal during the second arthroscopy because of suture irritation. Tripathy SK, Aggarwal A, Patel S, et al. McDonough PW, Bernstein RM. Medicine 2022;101:50(e32104). For bicondylar fractures, a median parapatellar incision can be used. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). [ 21] Matthewson et al [ 21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early 1 It has been proved that compression of the posterior border of . Malays Orthop J 2017;11:204. Hoffa fractures are caused by shear stress between the femoral condyle and tibial plateau. 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. Arastu MH, Kokke MC, Duffy PJ, et al. Medline, Embase, the Cochrane Library, Google Scholar, the China National Knowledge Infrastructure, and the China Biology Medicine disc were searched for relevant articles. Intra-articular dislocation of the patella. [Patella infera. Accessibility According to the internal fixation principle, the antiglide plate should be fixed in the posterior position. [66]. Unfallchirurg 2004;107:1521. A case report. [39]. A review of 23 patients. 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. (A) One 1.5mm Kirschner wire temporarily fixed the fracture block of the lateral condyle of the femur. Lee et al[13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. J Bone Joint Surg Am 2008;90:46370. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. [Treatment of extensive chondral defects of the patella after patellar dislocation]. [52] This fact reminds us that a Hoffa fracture evaluation should be a routine part of the lower-limb and pelvis examination with or without injury. We report a case of patellar dislocation with OCF in the weight-bearing area of LFC. The goals of treatment include restoration of function and esthetics. Somford MP, van Ooij B, Schafroth MU, et al. femoral shaft fracture presentation 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 . Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. -, Patel JM, Saleh KS, Burdick JA, Mauck RL. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. 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. If fractures are present they are usually associated with orbital rim or other significant craniofacial injuries. Technique for Treatment of Subchondral Compression Fracture of the Subchondral Impaction Fractures of the Medial Femoral Condyle in - LWW Arthroscopy. [30]. [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. Some error has occurred while processing your request. Callewier A, Monsaert A, Lamraski G. Lateral. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. Cureus 2016;8:e802. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. 1982;68:31725. [101]. [25]. Am J Sports Med 2008;36:37994. Some error has occurred while processing your request. Arthroscopy 2012;28:13817. [104]. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. eCollection 2020 Jun. The site is secure. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. Acta Chir Orthop Traumatol Cech. Cartilage. [2]. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. [37]. Manfredini M, Gildone A, Ferrante R, et al. [105]. Hoffa fragment associated with a femoral shaft fracture. [20]. 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 . [94]. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. Cheng S, Zaidi SF, Linnau KF. 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. Distal Femur Fractures - Trauma - Orthobullets Injury 2015;46:41921. Intra-articular corrective osteotomy for malunited. 2020 Jun 15;9 (6):e823-e828. Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. Am J Sports Med. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. Impaction Fracture of the Medial Femoral Condyle assessment of the anterior cruciate liga- ment with the anterior drawer and Lach- man tests was negative for laxity. (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. 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.
