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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. (B) AIMER was located at the outlet of the medial bone canal of the lateral condyle of the femur. Lateral radiographs of the affected knee were inspected for a . [48]. Fractures of the distal femur typically occur in the axial and sagittal planes. Arthroscopic. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. Plate fixation for Letenneur type I. Surgical treatment of femoral medial condyle fracture with lag screws Fracture of the Lateral Femoral Condyle | Journal of Orthopaedic 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. Khle J, Angele P, Balcarek P, et al. Screw insertion direction differs among operative approaches. Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. 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. Wang JY, Liu Y, Li Y, et al. Zeebregts CJ, Zimmerman KW, ten Duis HJ. Injury 2011;42:14958. Medicine (Baltimore). An unusual fracture of the lateral femoral condyle in a child. 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. [10]. Ercin E, Bilgili MG, Basaran SH, et al. 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. 2013;37:238594. The bone mass is missing at the fracture. 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. Knee Surg Sports Traumatol Arthrosc 2011;19:3209. At present, open reduction is often used to treat osteochondral fractures. Osteochondral injury after acute patellar dislocation in children and adolescents. The patellar height was in the normal range (Caton-Deschamp index 1.0). [18]. impacted and stress fractures. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. Autologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions. Jarit GJ, Kummer FJ, Gibber MJ, et al. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. 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. Please enable scripts and reload this page. Patellar dislocation with OCF in weight-bearing area of LFC is a rare injury in adolescents. Intra-articular dislocation of the patella. The widely known Letenneur classification not only clarifies the relationships between the fracture line and ligaments and soft tissue, but also has significance for clinical treatment and prognosis. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. A case report. (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. Federlin M, Krifka S, Herpich M, et al. Lateral femoral notch sign (knee) | Radiology Reference Article Other structures may be fractured at the same time due to the great forces experienced through the femur bones. [98]. patellar margin thus corresponding to impaction injuries. Nonunion of coronal shear fracture of femoral condyle. Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. In general, there has been a trend toward . Wolters Kluwer Health J Orthop Trauma 1994;8:1426. [83]. The distal femur is where the bone flares out like an upside-down funnel. 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). For simple lateral condylar Hoffa fractures, a patellar anterolateral approach is most commonly used. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. Coronal plane fracture of the femoral condyles: anatomy, injury patterns, and approach to management of the Hoffa fragment. [23]. Int Orthop. [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. Intertrochanteric femoral fractures occur mostly in the elderly, and the average age of onset is 66-76 years. Internal fixation with lag screws plus an antigliding plate for the, [88]. Starr AJ, Jones AL, Reinert CM. Ul Haq R, Modi P, Dhammi I, et al. Matthewson MH, Dandy DJ. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. Malunion: This happens when your broken bones don't line up correctly while they heal. Kapoor C, Merh A, Shah M, et al. [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. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. Posterior wall blowout in anterior cruciate ligament reconstruction: avoidance, recognition, and salvage. Arthroscopic-assisted fixation of. [7] The development of trochlear sulcus of femur was classified as type A according to Dejour et al,[8] and the TT-TG[9] was 15mm. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. 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. Acta Chir Orthop Traumatol Cech. [57]. Segmentation of the lateral femoral notch sign with MRI using a new Acute patellar dislocation in children and adolescents: a randomized clinical trial. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. Z Orthop Ihre Grenzgeb. Efficacy of multiple Acutrak hollow head compression screws in the, [68]. A rare case of unicondylar medial, [24]. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Med Sci Monit, 2012, 18: CS117CS120. Impaction Fracture of the Medial Femoral Condyle Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. Subchondral Impaction Fractures of the Medial Femoral Condyle in - LWW A patella that is stuck between the tibia and femur can be relocated naturally by flexing of the hip joint with the knee in 110 of flexion under local anesthesia. [40]. Bone contusion and associated meniscal and medial collateral - PubMed [5-9] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. Chin J Orthop Trauma 2009;9:8503. 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. 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%. Technique of reduction and fixation of unicondylar medial, [70]. Visual observation revealed significant right knee effusion and an inability to bear weight on the right lower extremity or flex his knee beyond 80. Impaction fracture of the medial femoral condyle - PubMed [17]. Injury, 2005, 36: 862865. Chin J Traumatol. 2012;40:191623. [10] Werner and Miller [11] reported that iatrogenic injury is a cause of Hoffa fracture . 2020 The Authors. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. [96]. Refixation of large osteochondral fractures after patella dislocation shows better mid- to long-term outcome compared with debridement. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. 2013;33:5118. classification; diagnosis; Hoffa fracture; injury mechanism; treatment. [33]. View Large Image Download Hi-res image Download (PPT) Please enable it to take advantage of the complete set of features! Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. Ji G, Wang S, Wang X, 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 . The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. [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. Sahu RL, Gupta P. Operative management of, [44]. We used the key words Hoffa fracture and coronal fracture of femoral condyle for the knowledge. 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PDF ssslideshare.com After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. [65]. -. * Correspondence: Lijiang He, Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Hangzhou, Zhejiang 311121, China (e-mail: [emailprotected]). [77]. The white arrow indicate the defect area. 3 Although the examined patients were not professional athletes, some differences between these groups are worth mentioning: in the athletes, the medial rather than the lateral condyle was Unfallchirurg 2004;107:1521. Knee Surg Sports Traumatol Arthrosc. [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. Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. 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. (PDF) Technique for Treatment of Subchondral Compression Fracture of modify the keyword list to augment your search. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. Osteochondral fracture (OCF) in weight-bearing area of lateral femoral condyle (LFC) is a rare combined injury caused by patellar dislocation. Nandy K, Raman R, Vijay RK, et al.