eCollection 2021 Jan. Uimonen MM, Repo JP, Huttunen TT, Nurmi H, Mattila VM, Paloneva J. Knee Surg Sports Traumatol Arthrosc. Soft tissues are retracted to . [100,101] To avoid damaging the cartilage in these cases, it is important to reduce the patella early and restore the patellofemoral joint stability by repairing the damaged medial soft tissues. [Treatment of extensive chondral defects of the patella after patellar dislocation]. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. [Resorbable pin refixation of an osteochondral fracture of the lateral femoral condyle due to traumatic patellar dislocation: case management, follow-up and strategy in adolescents]. Int Orthop 2015;39:124550. Lian X, Zeng YJ. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Potini VC, Gehrmann RM. J Pediatr Orthop B, 2013, 22: 344349. Research Article: Systematic Review and Meta-Analysis. Some error has occurred while processing your request. Nandy K, Raman R, Vijay RK, et al. The goals of treatment include restoration of function and esthetics. [48]. 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. Atesok K, Doral MN, Whipple T, et al. Iwai T, Hamada M, Miyama T, et al. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. [61]. The site is secure. Sasidharan B, Shetty S, Philip S, et al. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. An unusual fracture of the lateral femoral condyle in a child. Epub 2018 Oct 4. Am J Sports Med. 2001;17:5425. Soraganvi PC, Narayan Gowda B, Rajagopalakrishnan R, et al. Apropos of 128 cases]. Complained of swelling and pain of the right knee after spraining during sports activities, demonstrated painful limited motion. 5 and 6), and the lysholm score was 95 points, which was very good. [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. Acta Biomater, 2019, 93:222238. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. Unicondylar femoral fractures: therapeutic strategy and long-term results. Analysis of functional outcome of Hoffa fractures: a retrospective review of 32 patients. You will need surgery to repair your bone, and recovery can take a year or longer. The incidence ratio in male and female patients is in the range . Long term results of unicondylar fractures of the femur. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. 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%. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. Bicondylar. A case of distal femur medial condyle Hoffa type II(C) fracture treated with headless screws. [3,4] In 1888, Hoffa described coronal fracture of the femoral condyle but did not indicate the source of the previous reference. Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fractures--a prospective review of 18 patients. The funding sources have no role in study design, literature collection, review, data analysis, and manuscript preparation. [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. [41]. Li et al[25] used absorbable suture to treat OCF caused by patellar dislocation and achieved good medium-term results. [27]. 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. 3). Arthroscopic management of a posterior femoral condyle (Hoffa) fracture: surgical technique. Recurrence after patellar dislocation. [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. The CT classification[32] uses the anatomic femoral axis and a line parallel to the posterior cortex of the femoral condyle to divide the femoral condyle into a, b, and c regions. Acta Orthop Scand 1997;68:4246. [2] This fracture type was 1st described by Busch in 1869. Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. At present, open reduction is often used to treat osteochondral fractures. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. Accessibility Choudhary RK, Tice JW. 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). The authors have no funding and conflicts of interest to disclose. 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%. Li ZX, Song HH, Wang Q, et al. Intraoperative, [12]. Ercin E, Baca E, Kural C. Arthroscopic. Frangakis EK. doi: 10.1016/j.arthro.2006.11.029. Jabalameli M, Bagherifard A, Hadi H, et al. 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. Knee Surg Sports Traumatol Arthrosc. J Clin Orthop Trauma 2015;6:4650. 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. The injury to MCL was also observed with MRI. 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. J Knee Surg. After the osteochondral mass was fixed in situ to the lateral condyle of the femur, 2 suture ends of the posterior suture anchor penetrate into the front bone tunnels respectively, and after penetrating from the LFC, they are knotted and fixed with 2 suture ends of medial suture anchor respectively (Fig. [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. [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. (LTC, Lateral Tibial Condyle.) In these cases, the associated patellar fracture results from a combination of forces: direct trauma causing the Hoffa fracture and possible indirect injuries from sudden contraction of the quadriceps muscle causing a vertical patellar fracture.[23]. [21]. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. 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 appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. [5-9] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. McDonough PW, Bernstein RM. 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. 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. Arthroscopic-assisted fixation of. J Orthop Trauma 1999;13:13840. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. (C) CT examination of the left knee joint: the continuity of the subarticular bone of the lateral condyle of the left femur was interrupted. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. Epub 2007 Mar 23. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. Li R, Guo G, Chen B, Zhu L, Lin A. Arthroscopicallyassisted reduction and fixation of an old osteochondral fracture of the lateral femoral condyle. However, the latest biomechanical study[88] showed that lateral antiglide plate has greater anti-shearing strength than posterior fixation. This article discusses anatomic considerations, classification of condylar fractures, indications for surgery, treatment options, and complications. Intra-articular corrective osteotomy for malunited. [72]. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. Tsai et al[103] reported that surgical treatment is the 1st choice for Hoffa fracture accompanied by traumatic patella dislocation; if conservative treatment is adopted, the redislocation rate is as high as 40%. Neglected. Am J Sports Med. Introduction. Vaishya R, Singh AP, Dar IT, et al. osteochondral impaction fracture postsurgical (e.g. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. Xu Y, Li H, Yang HH, et al. Some error has occurred while processing your request. [8]. Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. 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. Would you like email updates of new search results? [97]. 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. [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. Irreducible, incarcerated vertical dislocation of patella into a. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. Patellar dislocation with OCF in weight-bearing area of LFC is a rare injury in adolescents. 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. following anterior cruciate ligament repair) Location The recognized sites of osteochondral defects are: femoral condyle (most common in the lateral aspect of the medial femoral condyle) humeral head talus capitellum of the humerus Staging 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. [9] The pain due to these combined injuries often exceeds that caused by the Hoffa fracture, which can lead physicians to miss the latter. A comparison of the clinical effect of two fixation methods on Hoffa fractures. [2]. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. Autologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. Knee Surg Sports Traumatol Arthrosc. The patient's treatment plan included 6 weeks of weight bearing as tolerated for the left lower extremity while wearing a knee brace that prevented the final 20 of knee extension, and a program of range-of-motion and progressive resistive exercises, with eventual emphasis on sport-specific activities. Osteochondral fractures of the lateral. Letenneur J, Labour PE, Rogez JM, et al. official website and that any information you provide is encrypted Biau DJ, Schranz PJ. Tan Y, Li H, Zheng Q, et al. [7]. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. Ercin E, Bilgili MG, Basaran SH, et al. Two cartilage masses can be seen during the operation. Matthewson MH, Dandy DJ. Wolters Kluwer Health Chauhan A. Irreducible, incarcerated vertical dislocation of the patella into a. 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). J Pediatr Orthop. A modified posterolateral approach for. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. (A) The fresh 1.5cm1.5cm fracture surface of the lateral condyle of femur was found under arthroscopy. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. 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. (B) AIMER was located at the outlet of the medial bone canal of the lateral condyle of the femur. FIGURE 2. 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. In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. Onay T, Glabi D, olak , et al. Two patients with osteochondral injury of the weight-bearing portion of the lateral. Complications of humerus fracture treatment. Please enable it to take advantage of the complete set of features! [53] In addition, partial nondisplaced Hoffa fractures are difficult to diagnose on anteroposterior and lateral views of the knee because the fracture lines often overlaps the side or lateral condyle, which can result in a missed diagnosis in as many as 30% of cases.[9,18]. Objective: To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. [3]. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. 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 J Knee Surg 2008;21:23540. [14]. Distal pulses and sensation were intact. At present, open reduction is often used to treat osteochondral fractures. [85]. Please enable scripts and reload this page. findings identifies vascular segments with diminished flow vascular injury Medial and lateral buttressing may be required if either fracture extends proximally in the same plane. Orthop J Sports Med. Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. Hoffa fractures are caused by shear stress between the femoral condyle and tibial plateau. Unfallchirurg 2004;107:1521. [ 21] Matthewson et al [ 21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. Treatment and prognosis. Acta Chir Orthop Traumatol Cech. 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