[9] The pain due to these combined injuries often exceeds that caused by the Hoffa fracture, which can lead physicians to miss the latter. Medicine 2022;101:50(e32104). Arastu MH, Kokke MC, Duffy PJ, et al. Ozturk A, Ozkan Y, Ozdemir RM. [10]. Open reduction and internal fixation are preferred. 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. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. Sanders TG, Paruchuri NB, Zlatkin MB. Xray examination of right knee joint: free bone mass can be seen at the anterior edge of the femur in the knee joint. Cancellous screws cannot achieve adequate compression[55] and require more surgical time to countersink. [12,37] Orthopedic surgeons treating these patients should be vigilant in diagnosing a Hoffa fracture; patients with undiagnosed injuries experience long-term knee pain and limited knee mobility. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. Bone Joint J 2013;95-B:116571. For tibial fractures, the use of bone plates or intramedullary nails is recommended if the condition of the local soft tissue is suitable. Jain A, Agrawal P, Chadha M, et al. In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). 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. Vaishya R, Singh AP, Dar IT, et al. The site is secure. Type 2 fractures require a . Meyer C, Enns P, Alt V, et al. Bookshelf [21,22], In some patients, a Hoffa fracture is associated with a patellar fracture. Soft tissues are retracted to . 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. Malunion: This happens when your broken bones don't line up correctly while they heal. Arthrosc Tech 2015;4:e299303. Jarit GJ, Kummer FJ, Gibber MJ, et al. [10,38] Local manifestations of a Hoffa fracture include knee swelling, pain, skin color changes (with or without skin defects), limited knee mobility, and a positive floating patella test. Please try after some time. [97]. 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.. [24]. FOIA We used the key words Hoffa fracture and coronal fracture of femoral condyle for the knowledge. Zhou S, Cai M, Huang K. Treatment of. 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. Disclaimer. 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. 2023 Jan;15(1):103-110. doi: 10.1111/os.13586. Medicine101(50):e32104, December 16, 2022. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). Jiang YR, Wang ZY, Zhang DB, et al. 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. [4]. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. [40]. Gao M, Tao J, Zhou Z, et al. 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%. Li R, Guo G, Chen B, Zhu L, Lin A. Arthroscopicallyassisted reduction and fixation of an old osteochondral fracture of the lateral femoral condyle. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. modify the keyword list to augment your search. Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by-nc-nd/4.0, Hoffa fracture of the femoral condyle: Injury mechanism, classification, diagnosis, and treatment, Articles in Google Scholar by Yabin Zhou, MD, Other articles in this journal by Yabin Zhou, MD, Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A meta-analysis of randomized controlled trails, Hoffa fracture combined with rotational dislocation of the knee joint: A novel case report, PET/CT-negative malignant spine tumor with pathologic fracture: A case report of malignant solitary bone plasmacytoma, Prognostic factors to survival of patients with chondroblastic osteosarcoma, Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis, Privacy Policy (Updated December 15, 2022). For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. 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. 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. Many author think these injuries are caused by the impact between the patella and femoral condyle with a knee flexed over 90. [21] Matthewson et al[21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early internal fixation and external fixation to avoid early weight bearing, and achieved good results. A case report. Internal fixation with headless compression screws and back buttress plate for. Intra-articular corrective osteotomy for malunited. Arthroscopy 2012;28:13817. After 1 year follow-up, good functional and radiographic outcome were obtained. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. [50]. 8600 Rockville Pike [54] However, popliteal and gastrocnemius muscle traction and foot or ankle movement can lead to fracture redisplacement,[5557] which can cause delayed fracture healing, nonunion, traumatic arthritis, knee dysfunction, and other complications. Making the diagnosis of a Hoffa fracture is challenging. 2). Frangakis EK. 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. J Bone Joint Surg Am 1974;56:4234. [8]. J Orthop Surg 2017;25:17. Chin J Orthop Trauma 2009;9:8503. Suture anchors are drilled into the posterolateral tibia to repair the meniscus to the meniscosynovial junction. [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. [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. Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. [7]. Arthroscopy. Manfredini M, Gildone A, Ferrante R, et al. Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro. Type III is an oblique fracture of the femoral condyle with the fracture line located anterior to the joint capsule, anterior cruciate ligament, lateral collateral ligament, popliteal tendon, and the lateral head of the gastrocnemius muscle. 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. Apropos of 128 cases]. Li WH, Li Y, Wang MY. J Trauma 2000;48:15960. Acta Orthop Belg 2001;67:1328. Plate fixation for Letenneur type I. Wu P, WB, Kong LC, et al. [10] Werner and Miller [11] reported that iatrogenic injury is a cause of Hoffa fracture . Treatment options include loose body removal, microfracture, multiple internal fixation and so on. Gelber PE, Erquicia J, Abat F, et al. Injury 2018;49:398403. J Knee Surg 2008;21:23540. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. Osteochondral fractures of the lateral. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. A hip fracture is a break that occurs in the upper part of the femur (thigh bone). 1). official website and that any information you provide is encrypted J Bone Joint Surg Br 1989;71:11820. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. Orthop J Sports Med. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. [104]. 1994;2:1926. (A) One 1.5mm Kirschner wire temporarily fixed the fracture block of the lateral condyle of the femur. Neglected. Zhao LL, Tong PJ, Xiao LW. 2007;41 Suppl 2:105-12. Acta Chir Orthop Traumatol Cech. [36]. [101]. 3021 Tibial plateau fractures - fixation (a) Two or three lag screws may be sufficient for simple split fractures (type l), though 'b) a buttress plate ard screws may be more secure. 2021;13(1_suppl):966S73S. 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. Introduction. 1). According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. Distal pulses and sensation were intact. At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: Reduce Pain Restore Movement Optimise Recovery What are Femoral Condyle Fractures? Intra-articular dislocation of the patella with associated, [26]. [31]. Paa L, Vesel R, Koi J, et al. Chauhan A. Irreducible, incarcerated vertical dislocation of the patella into a. Keyword Highlighting [96]. Federlin M, Krifka S, Herpich M, et al. 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. For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. Ul Haq R, Modi P, Dhammi I, et al. Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. 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]. [19]. Cureus 2016;8:e802. Sagittal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. Coronal plane fracture of the femoral condyles: anatomy, injury patterns, and approach to management of the Hoffa fragment. This method is also recommended for patients with osteoporosis, metaphyseal extension, or comminuted Hoffa fractures. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. Radiography can reveal fracture lines. The work cannot be changed in any way or used commercially without permission from the journal. Caton J, Deschamps G, Chambat P, et al. The bone mass is missing at the fracture. (A) Use of anterior cruciate ligament locator to assist drilling at the distal end of the femur. 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. [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. [20]. The exposed fracture line is initially fixed with a k-wire and screws are placed perpendicular to the fracture surface. [25] A cannulated screw combined with a plate is recommended in these cases. Surgically treated Hoffa Fractures with poor long-term functional results. Knee 2004;11:1257. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. [43]. Cruciate fracture of the distal femur: the double. Therefore, further studies are needed to improve the quality of Hoffa fracture reduction under arthroscopy. Baker BJ, Escobedo EM, Nork SE, et al. Hoffa fragment associated with a femoral shaft fracture. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. J Pediatr Orthop. Management of any globe injury generally takes precedence over fractures 1. 2001;17:5425. The term comminuted fracture refers to a bone that is broken in at least two places. The goals of treatment include restoration of function and esthetics. 2003;19:71721. 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. [59]. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. 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%. J Knee Surg 2013;26(Suppl 1):S8993. Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout: a cadaveric study. An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. 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. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. Arthroscopic-assisted fixation of. Data is temporarily unavailable. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. Clinical outcomes after absorbable suture fixation of patellar, [26]. Sun H, He QF, Huang YG, et al. After arthroscopic confirmation of Lateral Femoral Condyle (LFC) ostechondral fracture (HSL, Hill-Sachs-like Lesion) the anterolateral portal is enlarged to 2-3 cm. [64]. [30]. An attempt to treat Hoffa fractures under arthroscopy: A case report. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. 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. [92]. [9]. [93]. During the operation, we found that 2.5*2. 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). Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. Acta Orthop Scand 1997;68:4246. Three days after injury, the lateral parapatellar incision of the right knee was performed under general anesthesia, OCF reduction and fixation of the lateral condyle was performed. Operative. 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. Dhillon MS, Mootha AK, Bali K, et al. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. 2020 The Authors. 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. [89]. Allmann KH, Altehoefer C, Wildanger G, et al. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. Bioactive factors for cartilage repair and regeneration: improving delivery, retention, and activity. Appointments 216.444.2606. A review of 23 patients. J Orthop Trauma 1999;13:13840. For more information, please refer to our Privacy Policy. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . Difficulties involved in the Hoffa fractures [in German]. This sign represents a severe bone contusion caused by impression, and microfracturing, visible on MRI, and is suspect for an impacted (osteo)chondral fracture due to a tear of . Methods All patients with post-injury bi-plane radiographs and MRI images after sustaining a tear to the anterior cruciate ligament were included. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. Bicondylar. [104] To prevent habitual patellar dislocation, repair of the medial retinaculum complex or a combination of lateral retinacular release[14,105] and simultaneous patellar ligament insertion on the tibial tubercle is recommended. Introduction. [64] Open reduction and internal fixation is the 1st choice for the treatment of displaced Hoffa fractures, and it is also suitable for the treatment of nondisplaced Hoffa fractures. Careful consideration and attention to the principles of fracture management, and the role of the condyle as an articulating . Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. impacted and stress fractures. Your message has been successfully sent to your colleague. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. 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. Acta Orthop Traumatol Turc 2014;48:3837. Arthroscopy-assisted, [55]. [58]. (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. 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. Gerdy's tubercle osteotomy for the, [69]. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. 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. Irreducible, incarcerated vertical dislocation of patella into a. 2013;37:238594. [18]. [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. The distal femur is the area of the leg just above the knee joint. Autologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions. Headless compression screws are self-compressing and can be positioned beneath the outer cortex resulting in significantly greater axial compression, a higher load limit, and increased fracture stability. Cheng S, Zaidi SF, Linnau KF. 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. and transmitted securely. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation.