(B) The sutures passing through the bone canal and the corresponding sutures on the anchor were tightened and fixed. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. Injury, 2005, 36: 862865. impacted and stress fractures. [8]. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. Gerdy's tubercle osteotomy for the, [69]. Lateral femoral notch sign (knee) | Radiology Reference Article Factors of patellar instability: an anatomic radiographic study. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. Posterior wall blowout in anterior cruciate ligament reconstruction: avoidance, recognition, and salvage. Distal femur fractures most often occur either in older people whose bones . Technique for Treatment of Subchondral Compression Fracture of the Based on plate position, screws can be combined with a lateral antigliding plate[84] or a posterior antigliding plate.[55,87]. Am J Sports Med. Lateral Femoral Condyle (LFC) osteochondral fracture (HSL, Hill-Sachs-like Lesion) can be seen in 30 of knee flexion. This system allows the classification of comminuted femoral condyle fractures. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). Baker BJ, Escobedo EM, Nork SE, et al. Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Acta Orthop Traumatol Turc 2014;48:3837. [91]. 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. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. Braune C, Rehart S, Kerschbaumer F, Jger A. Open reduction and internal fixation are preferred. Intertrochanteric Fractures of the Femur | SpringerLink 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. Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. [90]. J Surg Case Rep 2012;2012:10. (A) The fresh 1.5cm1.5cm fracture surface of the lateral condyle of femur was found under arthroscopy. [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. [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. Lee et al[13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. osteochondral impaction fracture postsurgical (e.g. [60]. For local soft-tissue injuries, external fixation can be used, but this may delay the time to mobility restoration and affect therapeutic efficacy. Tsai CH, Hsu CJ, Hung CH, et al. 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 . Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. Arthroscopy. Arthroscopic-assisted fixation of. Research Article: Systematic Review and Meta-Analysis. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. Oral application of Qiangguyin Keli and alendronate sodium vitamin D3 tablets in postoperative anti-osteoporosis. Malays Orthop J 2017;11:204. Osteochondral defect | Radiology Reference Article | Radiopaedia.org Published by Wolters Kluwer Health, Inc. Transverse Hoffa's or deep osteochondral fracture? Sun H, He QF, Huang YG, et al. [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. An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. Osteochondral injuries of the knee in pediatric patients. Rev Chir Orthop Reparatrice Appar Mot. Distal Femur (Thighbone) Fractures of the Knee - OrthoInfo - AAOS Friederichs MG, Greis PE, Burks RT. Ostermann PA, Neumann K, Ekkernkamp A, et al. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. J Clin Orthop Trauma 2015;6:4650. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. sharing sensitive information, make sure youre on a federal Rofo. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. The authors have no conflicts of interest to disclose. [5]. As the knee is being extended and in full extension, it can be seen that femoral and tibial surfaces do not articulate with each other. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. A fracture is a broken bone. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. Cruciate fracture of the distal femur: the double. Wagih AM. The Letenneur classification[31] divides fractures into 3 types (Fig. [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. Technique of reduction and fixation of unicondylar medial, [70]. Transverse Hoffas or deep. Please try after some time. Unfallchirurg 2004;107:1521. The distal femur is the area of the leg just above the knee joint. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. Busam ML, Provencher MT, Bach BR. [1]. Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. [82]. Type 2 fractures require a . [14]. The most common way to fracture the femoral condyles is jumping from a large height. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. Life (Basel). Before Somford MP, van Ooij B, Schafroth MU, et al. official website and that any information you provide is encrypted CT examination 6months after operation: one screw internal fixation, regular external condyle cortex, good alignment at the end of fracture, callus growth and unclear fracture line could be seen in the right lateral femoral condyle. A comparison of the clinical effect of two fixation methods on Hoffa fractures. Surgical, [71]. You will need surgery to repair your bone, and recovery can take a year or longer. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. Some error has occurred while processing your request. [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. [105]. Ji G, Wang S, Wang X, et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. Lee SY, Niikura T, Iwakura T, et al. 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. 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. Objective: To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. [104]. Egol KA, Broder K, Fisher N, et al. Acta Orthop Traumatol Turc. http://creativecommons.org/licenses/by-nc-nd/4.0. Sasidharan B, Shetty S, Philip S, et al. [99]. 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. Nonunion of a, [62]. 1996 ). 1994;2:1926. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. [2]. Arthroscopic; Internal fixation; Osteochondral fracture; Suture anchor; TWINFIX Ti. [85]. 1986;14:11720. 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 . What is an Impact Fracture? - Definition from Corrosionpedia 5 and 6), and the lysholm score was 95 points, which was very good. The authors have no funding and conflicts of interest to disclose. This article discusses anatomic considerations, classification of condylar fractures, indications for surgery, treatment options, and complications. Data is temporarily unavailable. Preliminary X-ray examination showed osteochondral defects of LFC and loose body in knee joint (Fig. We report a case of patellar dislocation with OCF in the weight-bearing area of LFC. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Manfredini M, Gildone A, Ferrante R, et al. Some error has occurred while processing your request. Cartilage. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. 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. Operative. Treatment of osteochondral fracture of lateral femoral : Medicine Coronal plane fracture of the femoral condyles: anatomy, injury patterns, and approach to management of the Hoffa fragment. J Knee Surg. Arthroscopy-assisted, [55]. Primary traumatic patellar dislocation. Knee Surg Sports Traumatol Arthrosc. (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. [37]. 2020 Jun 15;9 (6):e823-e828. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity 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. 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. Orthopedics, 2016, 39: e362e366. Impaction fracture of the medial femoral condyle - PubMed Appointments 216.444.2606. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. PDF ssslideshare.com [80]. Li WH, Li Y, Wang MY. Suture anchor system is mostly used to repair rotator cuff and patellar tendon. [33] Dua and Shamshery[34] proposed a classification method that supplements the AO classification with proper surgical planning to optimize outcomes. J Knee Surg 2013;26(Suppl 1):S8993. 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. Federal government websites often end in .gov or .mil. modify the keyword list to augment your search. For more information, please refer to our Privacy Policy. Musculoskelet Surg 2012;96:4954. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). However, the latest biomechanical study[88] showed that lateral antiglide plate has greater anti-shearing strength than posterior fixation. 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. The Authors. Khle J, Angele P, Balcarek P, et al. Fracture of the Femoral Condyles - Physio.co.uk Injury 2005;36:8625. 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. Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. Careers. Jain A, Agrawal P, Chadha M, et al. [48]. Min L, Tu CQ, Wang GL, et al. Impaction Fracture of the Medial Femoral Condyle - JOSPT 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. After hospitalization, the patients underwent computed tomography scan and magnetic resonance examination. absorbable internal fixation; dislocation of patella; femoral condyle; osteochondral fracture. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. [84]. 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. [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. Osteochondral fractures of the lateral, [11]. Osteochondral fracture (OCF) in weight-bearing area of lateral femoral condyle (LFC) is a rare combined injury caused by patellar dislocation. [36]. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. [30]. This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. 2021. Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. 2013;185:61120. J Orthop Surg 2017;25:17. [93]. Surgical treatment of femoral medial condyle fracture with lag screws [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. McCarthy JJ, Parker RD. Ercin E, Baca E, Kural C. Arthroscopic. [95]. Technique for Treatment of Subchondral Compression Fracture of the Nonunion of a. FOIA Tripathy SK, Aggarwal A, Patel S, et al. This article reviews the mechanism, diagnosis, classification, and treatment of Hoffa fractures. [23]. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. Please try again soon. Nork SE, Segina DN, Aflatoon K, et al. Caton J, Deschamps G, Chambat P, et al. 1 It has been proved that compression of the posterior border of . 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%. [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. 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. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. Acta Biomater, 2019, 93:222238. [15]. During the operation, we found that 2.5*2. Palmu S, Kallio PE, Donell ST, et al. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. Lateral femoral condyle osteochondral fracture combined to patellar Chin J Traumatol. [53,91] However, some Hoffa fractures combined with a tear of the posterolateral horn of the lateral meniscus are identified intraoperatively, and tear of the lateral meniscus can be repaired with suture anchors. Monocondylar fractures of the femur: a review of 13 patients. Bone contusion and associated meniscal and medial collateral - PubMed In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. 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.. Acta Orthop Belg 2001;67:1328. You may be trying to access this site from a secured browser on the server. [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. A modified posterolateral approach for. Orbital blow-out fracture | Radiology Reference Article | Radiopaedia.org Internal fixation with headless compression screws and back buttress plate for. Vaishya R, Singh AP, Dar IT, et al. National Library of Medicine 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. Gesslein M, Merkl C, Bail HJ, et al. Arthroscopy. Med Sci Monit, 2012, 18: CS117CS120. Complications of humerus fracture treatment. The funding sources have no role in study design, literature collection, review, data analysis, and manuscript preparation. Emerg Radiol 2015;22:3378. 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. [89]. Epub 2020 Sep 18. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures .