A swashbuckler approach[34,72] can be used to treat bicondylar Hoffa fractures because it protects the Quadriceps femoris abdomen during surgery, allowing quick postoperative recovery of muscle strength and range of motion. [3]. Bone contusion and associated meniscal and medial collateral - PubMed [18]. 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. Vivek T, Saubhik Da, Sahil G, et al. Plain radiograph Min L, Tu CQ, Wang GL, et al. Letenneur J, Labour PE, Rogez JM, et al. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. McDonough PW, Bernstein RM. Primary traumatic patellar dislocation. 2017;84:4417. After arthroscopic confirmation of Lateral Femoral Condyle (LFC) ostechondral fracture (HSL, Hill-Sachs-like Lesion) the anterolateral portal is enlarged to 2-3 cm. In the AO classification, Hoffa fracture is classified as type B3.2. 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. A fracture is a broken bone. 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. However, some patients had suture removal during the second arthroscopy because of suture irritation. [14]. Please enable it to take advantage of the complete set of features! [42]. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. Mashoof AA, Scholl MD, Lahav A, et al. (A) The fresh 1.5cm1.5cm fracture surface of the lateral condyle of femur was found under arthroscopy. Type 2 fractures require a . Careful consideration and attention to the principles of fracture management, and the role of the condyle as an articulating . J Knee Surg. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. 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. 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). Moreover, even if the medial patellar retinaculum is strengthened, the patient still has symptoms such as anterior knee pain. [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. With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. Surgically treated Hoffa Fractures with poor long-term functional results. Would you like email updates of new search results? [20]. Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. Hoffa fractures are caused by shear stress between the femoral condyle and tibial plateau. [64]. Medicine (Baltimore). [30]. 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%. 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. [3,4] In 1888, Hoffa described coronal fracture of the femoral condyle but did not indicate the source of the previous reference. [6]. Orthop J Sports Med. [34] The clinical diagnosis of a Hoffa fracture relies on trauma history, physical examination, imaging, and other objective indicators as well as increased suspicion based on the history and positive signs.[35,36]. Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature. [28]. [85]. Conjoint bicondylar, [22]. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. [2,77] The heads of screws placed through the articular cartilage are countersunk to prevent damage to the cartilage. patellar margin thus corresponding to impaction injuries. [7]. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. Lateral femoral condyle osteochondral fracture combined to patellar [5]. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. Biau DJ, Schranz PJ. [92] Moreover, if soft tissue embedded within the fracture line prevents reduction, arthroscopy can distinguish the tissues and the degree of damage to assist restoration. A review of 23 patients. Before (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. ;Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Allmann KH, Altehoefer C, Wildanger G, et al. 2020 The Authors. absorbable internal fixation; dislocation of patella; femoral condyle; osteochondral fracture. Medicine101(50):e32104, December 16, 2022. femoral shaft fracture presentation In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. In these cases, magnetic resonance imaging (MRI) can show a lateral femoral notch sign: a depression in the lateral femoral condyle, which could indicate an ACL tear . Intra-operative fractures in primary total knee arthroplasty - a Injury 2005;36:8625. Cruciate fracture of the distal femur: the double. Acute patellar dislocation in children and adolescents: a randomized clinical trial. Iwai T, Hamada M, Miyama T, et al. On lateral radiographs, the normal femoral condyles overlap, and bone cortex interruption may not be visible. J Knee Surg. Soni A, Sen RK, Saini UC, et al. 2003;19:71721. [15]. HHS Vulnerability Disclosure, Help [Patella infera. Research Article: Systematic Review and Meta-Analysis. Autologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions. 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. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. [19]. Malays Orthop J 2017;11:204. 1996 ). [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. 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. Rofo. [100]. Screw insertion direction differs among operative approaches. Arthroscopy. [13] There are also many reports on OCF in non-weight-bearing area of LFC. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. Refixation of large osteochondral fractures after patella dislocation shows better mid- to long-term outcome compared with debridement. Internal fixation with headless compression screws and back buttress plate for. Nork SE, Segina DN, Aflatoon K, et al. Kapoor C, Merh A, Shah M, et al. Conjoint bicondylar, [45]. After 1 year follow-up, good functional and radiographic outcome were obtained. [75]. For Letenneur II and some Letenneur III fractures close to the posterior cortex of the femoral condyle, cannulated lag screw fixation is commonly used. Acta Biomater, 2019, 93:222238. Lateral Femoral Condyle (LFC) osteochondral fracture (HSL, Hill-Sachs-like Lesion) can be seen in 30 of knee flexion. Some error has occurred while processing your request. The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request. 2021. Pathology. You may search for similar articles that contain these same keywords or you may J Clin Orthop Trauma 2014;5:3841. 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. 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. 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. Soraganvi PC, Narayan Gowda B, Rajagopalakrishnan R, et al. [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. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. [51]. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. [77]. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . [37]. 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. (B) BULLET fixed at the entrance of the lateral bone canal of the distal femur. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Sun H, He QF, Huang YG, et al. Femoral Condyle Fractures - Symptoms, Causes, Treatment | Physio [96,97] Thus, closed reduction is recommended when Hoffa fracture is accompanied by patella dislocation. Arthrosc Tech 2015;4:e299303. 2018 Oct;21(5):308-310. doi: 10.1016/j.cjtee.2018.08.004. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. McCarthy JJ, Parker RD. [25] Loss of bone matrix results in brittle, weaker bones that break rather than bend with external force. Your message has been successfully sent to your colleague. Other structures may be fractured at the same time due to the great forces experienced through the femur bones. Impaction fracture of the medial femoral condyle - PubMed 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. Sagittal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. FIGURE 1. The specific mechanism of a Hoffa fracture is not well understood. [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. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Management of any globe injury generally takes precedence over fractures 1. 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. 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. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro. 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. Injury 2018;49:398403. MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence (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. Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fractures--a prospective review of 18 patients. Radiographic appearance doi: 10.1016/j.eats.2020.02.016. Injury, 2005, 36: 862865. Published by Wolters Kluwer Health, Inc. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. Sanders TG, Paruchuri NB, Zlatkin MB. Knee Surg Sports Traumatol Arthrosc. A biomechanical study[5] shown that several smaller-diameter screws cause less damage to the joint cartilage than larger-diameter screws but that both have the same tensile force. -, Patel JM, Saleh KS, Burdick JA, Mauck RL. Previous article . Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. Xu Y, Li H, Yang HH, et al. 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. Baker BJ, Escobedo EM, Nork SE, et al. Bartonicek J, Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. [7]. Osteochondral Fracture Lateral Femoral Condyle Treated with - Hindawi Dhillon MS, Mootha AK, Bali K, et al. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. Search for Similar Articles 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. Fracture of the Lateral Femoral Condyle | Journal of Orthopaedic [4]. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. You may search for similar articles that contain these same keywords or you may Li et al[25] used absorbable suture to treat OCF caused by patellar dislocation and achieved good medium-term results. 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. Neglected. -, Biau DJ, Schranz PJ. Musculoskelet Surg 2012;96:4954. [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. 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. 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. [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. [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. For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Hingelbaum S, Best R, Huth J, et al. Friederichs MG, Greis PE, Burks RT. [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. Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. This article discusses anatomic considerations, classification of condylar fractures, indications for surgery, treatment options, and complications. (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. Injury 1989;20:3714. Comminuted Fracture: Symptoms, Causes & Treatment - Cleveland Clinic 2001;17:5425. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. Repair of displaced partial articular fracture of the distal femur: the. Dejour H, Walch G, Nove-Josserand L, et al. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. Wagih AM. Arthroscopy 1996;12:2247. Wang JY, Liu Y, Li Y, et al. Recurrence after patellar dislocation. A patient, 15-year-old, female student. Am J Sports Med. [31]. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Am J Sports Med. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. 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. doi: 10.1097/MD.0000000000032104. 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. 8600 Rockville Pike Operative. [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.
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