impaction fracture lateral femoral condyle treatment

Operative. Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. 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. Long term results of unicondylar fractures of the femur. For bicondylar fractures, a median parapatellar incision can be used. A comparison of the clinical effect of two fixation methods on Hoffa fractures. [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. [97]. [43]. Iwai T, Hamada M, Miyama T, et al. [19] Therefore, lateral condyle fracture is significantly more common than medial condyle fracture. How to cite this article: Wu L, Liu C, Jiang B, He L. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. [101]. Int Orthop. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. Mashoof et al[11] reported 7 cases of OCF in the weight-bearing area of LFC caused by patellar dislocation, of which 3 cases were treated with bioabsorbable screw fixation, but the follow-up results were not reported. deep lateral sulcus sign - depression of lateral femoral condyle representing impaction fracture anterior tibial translocation sign Segond fracture arcuate fracture joint effusion CT Considered to have high specificity and sensitivity in detecting anterior cruciate ligament disruption 6. doi: 10.1097/MD.0000000000032104. [25] A cannulated screw combined with a plate is recommended in these cases. [102]. Hawkins et al[18] found that the recurrent dislocation rate of patients with primary patellar dislocation is related to congenital femoral trochlear dysplasia, high patellar position and large TT-TG. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. Type II is a fracture horizontal to the base of the posterior condyle with fracture lines located posterior to the attachment point of the lateral collateral ligament. Two patients with osteochondral injury of the weight-bearing portion of the lateral. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. A 15-year-old female student accidentally sprained her right knee while participating in sports activities. The bone contusions on the lateral femoral condyle, lateral aspect of the tibial plateau, medial femoral condyle, and medial aspect of the tibial plateau were documented. The distal femur is where the bone flares out like an upside-down funnel. Jarit GJ, Kummer FJ, Gibber MJ, et al. Moreover, the placement of a posterior antiglide plate with screws strips more soft tissue, especially the insertion of the gastrocnemius heads, and may destroy the blood supply to the fragments. In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. Dave LY, Nyland J, Caborn DN. The anatomical plate for distal medial condyle fracture of femur should be developed as soon as possible. Would you like email updates of new search results? Vaishya R, Singh AP, Dar IT, et al. 2021. 1 It has been proved that compression of the posterior border of . Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. [9] The pain due to these combined injuries often exceeds that caused by the Hoffa fracture, which can lead physicians to miss the latter. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. [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. Rofo. [48]. Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. Sanders TG, Paruchuri NB, Zlatkin MB. Xu Y, Li H, Yang HH, et al. Z Orthop Ihre Grenzgeb. Werner BC, Miller MD. Injury 2011;42:14958. Bone Joint J 2013;95-B:116571. [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. [43] If radiographic examination is not diagnostic but a Hoffa fracture is suspected, a CT scan, which is the gold standard for diagnosis of a Hoffa fracture, should be performed. The patient was evaluated by the physical therapist 2 days after his injury. Medicine (Baltimore). [5-9] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. [37]. Gang et al[20] found that there was no statistically significant difference between surgical treatment and non-surgical treatment in patients with patellar side injury of medial collateral ligament of patella. Reconstructive osteotomy for a malunited medial. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. (B) The suture of the lateral condyle of the femur is still fixed on the surface. Li R, Guo G, Chen B, Zhu L, Lin A. Arthroscopicallyassisted reduction and fixation of an old osteochondral fracture of the lateral femoral condyle. Radiography can reveal fracture lines. Choudhary RK, Tice JW. Please try again soon. Two cartilage masses can be seen during the operation. HHS Vulnerability Disclosure, Help For simple lateral condylar Hoffa fractures, a patellar anterolateral approach is most commonly used. 2001;17:5425. Gelber PE, Erquicia J, Abat F, et al. Clinical outcomes after absorbable suture fixation of patellar, [26]. Unfallchirurg 2004;107:1521. The site is secure. 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 case of distal femur medial condyle Hoffa type II(C) fracture treated with headless screws. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. Somford MP, van Ooij B, Schafroth MU, et al. Introduction. [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]. 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. Min L, Tu CQ, Wang GL, et al. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. J Orthop Trauma 2002;16:17881. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. The tears of the lateral meniscus and medial meniscus were detected during arthroscopy. [82,83] A biomechanical study by Li et al[84] demonstrated that plates combined with screws more firmly fixed the femoral condyle, reducing the probability of fracture displacement. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. 2017;30:37884. During complete anterior cruciate ligament (ACL) tears in pivoting mechanisms, the area of the lateral femoral condyle (LFC) localized just above the anterior third of the lateral meniscus (LM) impacts the posterior border of the lateral tibial plateau (LTP), which may result in a subchondral compression fracture. J Clin Orthop Trauma 2015;6:4650. Ercin E, Baca E, Kural C. Arthroscopic. Knee Surg Sports Traumatol Arthrosc. Antigliding plating for Letenneur type I Hoffa fractures. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. [5]. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. [27]. Am J Sports Med. 2012;40:191623. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. 1996 ). (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. [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. Transverse Hoffa's or deep osteochondral fracture? Bali K, Mootha AK, Krishnan V, et al. [50]. [82]. This method is also recommended for patients with osteoporosis, metaphyseal extension, or comminuted Hoffa fractures. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. patellar margin thus corresponding to impaction injuries. [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. 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. 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. [20]. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. Busam ML, Provencher MT, Bach BR. Before Osteochondral injuries of the knee in pediatric patients. Highlight selected keywords in the article text. [2] This fracture type was 1st described by Busch in 1869. (LTC, Lateral Tibial Condyle.) The work cannot be changed in any way or used commercially without permission from the journal. [20]. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Medicine 2022;101:50(e32104). However, the latest biomechanical study[88] showed that lateral antiglide plate has greater anti-shearing strength than posterior fixation. 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. A rare case of bicondylar. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. 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. J Bone Joint Surg Am 2005;87:5649. Soft tissues are retracted to . Lee SY, Niikura T, Iwakura T, et al. Lateral-view radiograph of the left knee demonstrating an abnormally deep depression of the medial condylopatellar sulcus (arrow). Refixation of large osteochondral fractures after patella dislocation shows better mid- to long-term outcome compared with debridement. [7]. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. [6]. Smith EJ, Crichlow TP, Roberts PH. [Patella infera. [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. The authors have no conflicts of interest to disclose. [10]. Open reduction and internal fixation are preferred. [18]. Paa L, Vesel R, Koi J, et al. A patient, 15-year-old, female student. [21] In contrast to unicondylar Hoffa fracture, a bicondylar Hoffa fracture is caused by a posterior and upward directed force and is not associated with knee valgus. Arastu MH, Kokke MC, Duffy PJ, et al. [78]. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. (C) The free edge of the anterior foot of the meniscus was rough (degree I). Shetty GM, Wang JH, Kim SK, et al. Materials and methods: This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. Nandy K, Raman R, Vijay RK, et al. Bartonicek J, Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. At present, open reduction is often used to treat osteochondral fractures. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. Oper Dent 2007;32:25160. Published by Wolters Kluwer Health, Inc. Sahu RL, Gupta P. Operative management of, [44]. [58]. Fixation with headless screws can reduce the degree of cartilage injury. osteochondral impaction fracture postsurgical (e.g. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. [33]. Gerdy's tubercle osteotomy for the, [69]. Am J Sports Med 2008;36:37994. Hoffa's fractures. Search for Similar Articles Nonunion of a, [62]. Arthroscopy 2012;28:13817. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. [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. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. Frangakis EK. 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]. Manfredini M, Gildone A, Ferrante R, et al. Meyer C, Enns P, Alt V, et al. Screw insertion direction differs among operative approaches. Maenpaa H, Huhtala H, Lehto MU. Data is temporarily unavailable. Internal fixation with lag screws plus an antigliding plate for the, [88]. [29]. Bioactive factors for cartilage repair and regeneration: improving delivery, retention, and activity. Potini VC, Gehrmann RM. Int Orthop 2015;39:124550. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. J Pediatr Orthop B, 2013, 22: 344349. doi: 10.1016/j.arthro.2006.11.029. Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. Dejour H, Walch G, Nove-Josserand L, 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. Arthroscopy. 2017;84:4417. [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. [77]. [93]. Acta Biomater, 2019, 93:222238. Based on plate position, screws can be combined with a lateral antigliding plate[84] or a posterior antigliding plate.[55,87]. Factors of patellar instability: an anatomic radiographic study. [91]. [4]. Gao M, Tao J, Zhou Z, et al. Arthroscopic; Internal fixation; Osteochondral fracture; Suture anchor; TWINFIX Ti. Technique of reduction and fixation of unicondylar medial, [70]. [3]. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. Sun H, He QF, Huang YG, et al. 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 . 2013;33:5118. Callewier A, Monsaert A, Lamraski G. Lateral. Monocondylar fractures of the femur: a review of 13 patients. [16]. Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. [10] Werner and Miller [11] reported that iatrogenic injury is a cause of Hoffa fracture . Xray examination of right knee joint: free bone mass can be seen at the anterior edge of the femur in the knee joint. The distal femur is the area of the leg just above the knee joint. [47]. Redislocation in 37/75 patients followed for 6-24 years. Intra-articular dislocation of the patella. [9]. Biau DJ, Schranz PJ. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. Distal pulses and sensation were intact. Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. J Pediatr Orthop. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). Your message has been successfully sent to your colleague. [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. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. [96,97] Thus, closed reduction is recommended when Hoffa fracture is accompanied by patella dislocation. Complained of swelling and pain of the right knee after spraining during sports activities, demonstrated painful limited motion. 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. Sharath RK, Gadi D, Grover A, et al. [95]. Research Article: Systematic Review and Meta-Analysis. Fractures of the distal femur typically occur in the axial and sagittal planes. [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. Familiarity with the characteristics of Hoffa fracture on various imaging modalities and an understanding of the mechanism and likelihood of combined injuries contribute to the timely and accurate diagnosis of Hoffa fracture and avoiding misdiagnosis. 1). [92]. 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 . For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. 1986;14:11720.

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