A case of distal femur medial condyle Hoffa type II(C) fracture treated with headless screws. absorbable internal fixation; dislocation of patella; femoral condyle; osteochondral fracture. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Friederichs MG, Greis PE, Burks RT. 2001;17:5425. The swashbuckler: a modified anterior approach for fractures of the distal femur. McCarthy JJ, Parker RD. Search for Similar Articles 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. Visual observation revealed significant right knee effusion and an inability to bear weight on the right lower extremity or flex his knee beyond 80. Shah JN, Howard JS, Flanigan DC, et al. Somford MP, van Ooij B, Schafroth MU, et al. Ercin E, Bilgili MG, Basaran SH, et al. Liebergall M, Wilber JH, Mosheiff R, et al. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. Transverse Hoffa's or deep osteochondral fracture? Arthroscopy 1996;12:2247. 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.. [23]. Published by Wolters Kluwer Health, Inc. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. [5-9] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Epub 2007 Mar 23. Orthopedics, 2016, 39: e362e366. Transverse Hoffa's or deep osteochondral fracture? [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. [10]. [84]. (A) Through the hollow needle channel of the femoral intercondylar fossa, the folding corner of the PDS line are exposed to the knee joint cavity through the bone canal. [10]. Acta Chir Orthop Traumatol Cech. your express consent. 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. At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: Reduce Pain Restore Movement Optimise Recovery What are Femoral Condyle Fractures? [12,13] Most researchers[2,7,14] currently believe that when the knee is in 90 of flexion and emergency braking is performed while driving a car, an axial force in either a varus or valgus direction is transferred from the proximal femur to the femoral condyle. Med Sci Monit, 2012, 18: CS117CS120. Before 2013;37:238594. Technique for Treatment of Subchondral Compression Fracture of the Lateral Femoral Condyle Associated With ACL Tear Technique for Treatment of Subchondral Compression Fracture of the Lateral Femoral Condyle Associated With ACL Tear Arthrosc Tech. This is the first case to apply the suture anchor system to the reduction and fixation of fracture. Data is temporarily unavailable. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. [90]. 1986;14:11720. Primary traumatic patellar dislocation. Unicondylar femoral fractures: therapeutic strategy and long-term results. Introduction. Comminuted fractures are caused by severe traumas like car accidents. [98]. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. [ 21] Matthewson et al [ 21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early Agarwal S, Giannoudis PV, Smith RM. Callewier A, Monsaert A, Lamraski G. Lateral. 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. Long term results of unicondylar fractures of the femur. Keywords: Moreover, even if the medial patellar retinaculum is strengthened, the patient still has symptoms such as anterior knee pain. 1). Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. Maenpaa H, Huhtala H, Lehto MU. Many author think these injuries are caused by the impact between the patella and femoral condyle with a knee flexed over 90. Int Orthop. [6]. may email you for journal alerts and information, but is committed 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. [9]. Arthroscopic-assisted fixation of. Calmet J, Mellado JM, Garcia Forcada IL, et al. Gerdy's tubercle osteotomy for the, [69]. The https:// ensures that you are connecting to the Caton J, Deschamps G, Chambat P, et al. 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. At the same time, forces on the distal tibia are transferred to the tibial plateau, resulting in great shear stress between the femoral condyle and the tibial plateau. In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. Epub 2022 Nov 15. [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. [17,18] Magnetic resonance imaging (MRI) should be performed when injury is suspected to the meniscus, cruciate ligament, collateral ligament, or other soft tissues to determine the extent of injury,[32] develop appropriate surgical plans, and accurately assess prognosis. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. 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. Nonunion of a, [62]. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. [21]. [27]. A lateral incision plus Gerdy tubercle osteotomy provides full exposure[68] especially in cases of coronal fracture of the lateral condyle. 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. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. For tibial fractures, the use of bone plates or intramedullary nails is recommended if the condition of the local soft tissue is suitable. J Orthop Surg Res 2012;7:21. Matthewson MH, Dandy DJ. Arthroscopic management of a posterior femoral condyle (Hoffa) fracture: surgical technique. Manfredini M, Gildone A, Ferrante R, et al. Reconstructive osteotomy for a malunited medial. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [1]. 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. A 15-year-old female student accidentally sprained her right knee while participating in sports activities. A meta-analysis by Khle et al[6] show that there is no unified treatment for osteochondral fractures (OCF) of knee joint at present, and the overall failure rate is 17%. Am J Sports Med. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. J Bone Joint Surg Br 1989;71:11820. Following Letenneur classification of coronal fractures of the femoral condyle in the 1970s and the publication of the second version of the Manual of Internal Fixation, the Hoffa fracture has become more widely recognized by orthopedists. Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. Please enable scripts and reload this page. [Patella infera. Internal fixation with lag screws plus an antigliding plate for the, [88]. 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. 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). Management of any globe injury generally takes precedence over fractures 1. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. Zhou S, Cai M, Huang K. Treatment of. Bartonicek J, Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. 2007 Oct;23(10):1133.e1-4. Baker BJ, Escobedo EM, Nork SE, et al. Highlight selected keywords in the article text. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. 2). Making the diagnosis of a Hoffa fracture is challenging. Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. Nork SE, Segina DN, Aflatoon K, et al. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. J Bone Joint Surg Am 2008;90:46370. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. doi: 10.1016/j.arthro.2006.11.029. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. Injury, 2005, 36: 862865. Suture anchors are drilled into the posterolateral tibia to repair the meniscus to the meniscosynovial junction. Soft tissues are retracted to . Nakagawa S, Arai Y, Inoue H, et al. Xu Y, Li H, Yang HH, et al. In addition, the lateral antiglide plate can provide stable support, and in combination with autologous bone grafting can promote fracture healing,[38,55,89] which is especially useful for treating old Hoffa fractures. Transverse Hoffas or deep. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. Report of 20 cases [in French]. Surgical, [71]. Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. The site is secure. Ozturk A, Ozkan Y, Ozdemir RM. Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. Intertrochanteric femoral fractures account for 3.13% of total adult fractures, 24.56% of femoral fractures, and 50% of proximal femoral fractures (Koval et al. Pathology. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. The .gov means its official. (C) CT examination of the left knee joint: the continuity of the subarticular bone of the lateral condyle of the left femur was interrupted. Zeebregts CJ, Zimmerman KW, ten Duis HJ. Some error has occurred while processing your request. modify the keyword list to augment your search. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Arthroscopic. In the AO classification, Hoffa fracture is classified as type B3.2. computed tomography scan and magnetic resonance (MRI) examination of knee joint further confirmed loose body within the knee joint, osteochondral defect in weight-bearing area of LFC and avulsion of medial patellofemoral ligament (Fig. Please enable it to take advantage of the complete set of features! [47]. [16]. Your message has been successfully sent to your colleague. Letenneur J, Labour PE, Rogez JM, et al. The patellar height was in the normal range (Caton-Deschamp index 1.0). to maintaining your privacy and will not share your personal information without Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. osteochondral impaction fracture postsurgical (e.g. A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. 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. Paa L, Vesel R, Koi J, et al. Plate fixation for Letenneur type I. 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. [48]. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. 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 . Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. The bone mass is missing at the fracture. Therefore, further studies are needed to improve the quality of Hoffa fracture reduction under arthroscopy. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). Sahu RL, Gupta P. Operative management of, [44]. Careers. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Arthroscopy-assisted, [55]. FIGURE 2. [91]. Operative. Two cartilage masses can be seen during the operation. 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). An unusual fracture of the lateral femoral condyle in a child. Malays Orthop J 2017;11:204. 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. 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. Khle J, Angele P, Balcarek P, et al. 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. Arthroscopy 2012;28:13817. Ul Haq R, Modi P, Dhammi I, et al. During the operation, 2 4.5mm anchor (Smith @ nephew TIWNFIX Ultra PK Suture Anchor) was inserted into the posterior edge and medial edge of the cartilage mass in the weight-bearing area, and then 2 non-absorbable sutures on each anchor were replaced by an absorbable suture (ETHICON VICRYL PLUS VCP359H), and finally the 2 ends of the absorbable suture were knotted to prevent sliding. Injury 2005;36:8625. Arthroscopy 2011;27:81724. Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. Treatment and prognosis. Chin J Traumatol. Meta plate and cannulated screw fixation for, [86]. Impact fractures can be classified either as ductile or brittle depending on the elongation pattern that is present. 2023 Jan;15(1):103-110. doi: 10.1111/os.13586. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd. Xray examination of right knee joint: free bone mass can be seen at, (A) MRI examination of the right knee joint: the bone continuity at the, (A) The fresh 1.5 cm 1.5 cm fracture surface of the lateral, (A) One 1.5 mm Kirschner wire temporarily fixed the fracture block of the, (A) Use of anterior cruciate ligament locator to assist drilling at the distal, (A) Through the hollow needle channel of the femoral intercondylar fossa, the folding, Surgical diagrams (A: osteochondral fracture, Surgical diagrams (A: osteochondral fracture of the lateral femoral condyle; B: fixation of, CT examination 6 months after operation: one screw internal fixation, regular external condyle, (A) A blurred fracture line can be seen at the fracture of the, MeSH [4]. Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. [17]. Arthroscopy-assisted fracture fixation. Radiographic appearance View Large Image Download Hi-res image Download (PPT) [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. J Bone Joint Surg Am 1974;56:4234. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. 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. Methods All patients with post-injury bi-plane radiographs and MRI images after sustaining a tear to the anterior cruciate ligament were included. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. Recurrence after patellar dislocation. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. J Knee Surg. The white arrow indicate the defect area. Wu, Liang MMa; Liu, Chao BMb; Jiang, Bing BMc; He, Lijiang MMd,*, a Department of Orthopedic Surgery, First Peoples Hospital of Linpin District, Hangzhou, Zhejiang, China, b Department of General Surgery, Medicine Faculty of Universitas Prima Indonesia, North Sumatra, Indonesia, c Department of General Surgery, Daocheng Country Peoples Hospital, Sichuan, China. Radiographs of knee joint show loose body in joint. Technique of reduction and fixation of unicondylar medial, [70]. The specific mechanism of a Hoffa fracture is not well understood. However, Gavaskar et al[2] argued that no evidence confirms this correlation. Monocondylar fractures of the femur: a review of 13 patients. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. 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). Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. Medial and lateral buttressing may be required if either fracture extends proximally in the same plane. Soni A, Sen RK, Saini UC, et al. Frangakis EK. J Trauma 2000;48:15960. Fixation with headless screws can reduce the degree of cartilage injury. Surgical versus nonsurgical treatments of acute primary patellar dislocation with special emphasis on the MPFL injury patterns. 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.

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