After 1 year follow-up, good functional and radiographic outcome were obtained. official website and that any information you provide is encrypted 5cm cartilage mass was stripped from nonweight-bearing area of the LFC, and no osteochondral mass was found at the medial edge of patella (Fig. Published by Wolters Kluwer Health, Inc. [78] Previous studies showed the use of many screws to fix the Hoffa fracture, such as cancellous, cannulated, and headless used in a lag technique. Dejour H, Walch G, Nove-Josserand L, et al. Meta plate and cannulated screw fixation for, [86]. Acute patellar dislocation in children and adolescents: a randomized clinical trial. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. An attempt to treat Hoffa fractures under arthroscopy: A case report. J Orthop Trauma 2002;16:17881. Tripathy SK, Aggarwal A, Patel S, et al. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). [13] There are also many reports on OCF in non-weight-bearing area of LFC. Gesslein M, Merkl C, Bail HJ, et al. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. Hoffa nonunion, two cases treated with headless compression screws. [20]. 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. Three types of fracture are defined based on the coronal fracture line (Fig. [21,22], In some patients, a Hoffa fracture is associated with a patellar fracture. Westmoreland GL, McLaurin TM, Hutton WC. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. For Letenneur II and some Letenneur III fractures close to the posterior cortex of the femoral condyle, cannulated lag screw fixation is commonly used. 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. [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. Oper Dent 2007;32:25160. 2020 The Authors. Search for Similar Articles Lee SY, Niikura T, Iwakura T, et al. However, Gavaskar et al[2] argued that no evidence confirms this correlation. [28]. Cartilage. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. Letenneur J, Labour PE, Rogez JM, 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. [31]. We report a case of patellar dislocation with OCF in the weight-bearing area of LFC. Li WH, Li Y, Wang MY. In this paper, three cases of osteochondral fracture of lateral femoral condyle were treated with arthroscopic TWINFIX Ti suture anchor internal fixation, and good results were obtained. In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. 1). Some error has occurred while processing your request. Arthroscopic-assisted fixation of. doi: 10.1016/j.eats.2020.02.016. Sanders TG, Paruchuri NB, Zlatkin MB. [30]. 2021 Jan 26;9(1):2325967120974649. doi: 10.1177/2325967120974649. Complications of anterior cruciate ligament reconstruction with bone-patellar tendon-bone constructs: care and prevention. 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 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. [9]. * Correspondence: Lijiang He, Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Hangzhou, Zhejiang 311121, China (e-mail: [emailprotected]). The work cannot be changed in any way or used commercially without permission from the journal. 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 . [99]. Previous article . This is the first case to apply the suture anchor system to the reduction and fixation of fracture. Type 2 fractures require a . Please enable scripts and reload this page. Int Orthop. Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. 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. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. The patellar height was in the normal range (Caton-Deschamp index 1.0). Sasidharan B, Shetty S, Philip S, et al. 2). Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. osteochondral impaction fracture postsurgical (e.g. Treatment and prognosis. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. [29]. In general, there has been a trend toward . Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. [50,51] An open supracondylar- intercondylar distal femoral fracture has a 2.8 times more chance of a Hoffa fracture than a closed distal femoral fracture. [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Anchor absorbable suture bridge fixation is rigid enough, which can avoid second operation, save cost and good outcome could be expected, which is worth exploring; Of course, a large number of clinical data are needed for further comparative study. [19]. Two patients with osteochondral injury of the weight-bearing portion of the lateral. You may search for similar articles that contain these same keywords or you may Impact fractures are due to track formation and propagation. (B) AIMER was located at the outlet of the medial bone canal of the lateral condyle of the femur. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. [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]. [23]. The white arrow indicate the defect area. Medicine (Baltimore). Emerg Radiol 2015;22:3378. 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. YZ and YP contributed equally to this work. J Trauma 2000;48:15960. Maenpaa H, Huhtala H, Lehto MU. Nork SE, Segina DN, Aflatoon K, et al. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. Federal government websites often end in .gov or .mil. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. [91]. In these fractures, the popliteus tendon and the lateral head of the gastrocnemius muscle remain attached to the fragment. Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. 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. [18]. Pa a et al[17] reported that 10 patients with patellar osteochondral mass less than 2.7mm2 caused by patellar dislocation still achieved good function only by taking out the loose body, and no patellar dislocation was found. Epub 2022 Nov 15. 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. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. [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]. 2013;33:5118. 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. Transverse Hoffa's or deep osteochondral fracture? Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa's fracture with patellar dislocation - a rare case. (B) 1.5cm1.5cm free bone was found in the knee joint cavity, and the bone fracture was intact. J Orthop Trauma 1999;13:13840. 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. [9] The pain due to these combined injuries often exceeds that caused by the Hoffa fracture, which can lead physicians to miss the latter. normal vital signs. Bone Joint J 2013;95-B:116571. [89]. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. You may be trying to access this site from a secured browser on the server. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. Jarit GJ, Kummer FJ, Gibber MJ, et al. 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). Accessibility Incarcerated patellar tendon in. sharing sensitive information, make sure youre on a federal Ozturk A, Ozkan Y, Ozdemir RM. 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. Ji G, Wang S, Wang X, et al. FIGURE 1. (LTC, Lateral Tibial Condyle.) Matthewson MH, Dandy DJ. The natural history. 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. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. Meyer C, Enns P, Alt V, et al. Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. 1). Distal femur fractures most often occur either in older people whose bones . Refixation of large osteochondral fractures after patella dislocation shows better mid- to long-term outcome compared with debridement. Before Ann Chir 1978;32:2139. Radiographs of knee joint show loose body in joint. [72]. Get new journal Tables of Contents sent right to your email inbox, December 16, 2022 - Volume 101 - Issue 50, Creative Commons Attribution License 4.0 (CCBY), Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report, Articles in Google Scholar by Liang Wu, MM, Other articles in this journal by Liang Wu, MM, Benign optic nerve gliomas in an adult: A case report, Analysis of the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture: A review, A bibliometric and emerging trend analysis on stress granules from 2011 to 2020: A systematic review and bibliometrics analysis, Inhaled opioids for cancer pain relief: A narrative review, Primary seminoma of prostate in a patient with Klinefelter syndrome: A case report, Privacy Policy (Updated December 15, 2022). Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. Open reduction and internal fixation are preferred. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. [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. ;Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. [40]. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. Keywords: 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. (A) Use of anterior cruciate ligament locator to assist drilling at the distal end of the femur. 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. Acta Orthop Belg 2001;67:1328. Please try again soon. Kapoor C, Merh A, Shah M, et al. Gao M, Tao J, Zhou Z, et al. The patient was referred to an or- thopaedic surgeon, who recommended conservative management. [66]. J Pediatr Orthop B, 2013, 22: 344349. 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%. [25] Loss of bone matrix results in brittle, weaker bones that break rather than bend with external force. 1 It has been proved that compression of the posterior border of . Atesok K, Doral MN, Whipple T, et al. Knee Surg Sports Traumatol Arthrosc. [ 21] Matthewson et al [ 21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early [10] Werner and Miller [11] reported that iatrogenic injury is a cause of Hoffa fracture . J Orthop Trauma 2006;20:2736. Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. 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). 2018 Oct;21(5):308-310. doi: 10.1016/j.cjtee.2018.08.004. J Bone Joint Surg Am 2006;88:22704. HHS Vulnerability Disclosure, Help The Letenneur classification, computed tomography (CT) classification, the AO classification, and the AO classification with supplement are widely used in clinics to categorize Hoffa fractures. [33] Dua and Shamshery[34] proposed a classification method that supplements the AO classification with proper surgical planning to optimize outcomes. [5]. 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. Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. [57]. When patients have tenderness along the medial edge of patella and knee joint effusion, it is necessary to actively improve MRI examination, to rule out osteochondral injury. Injury 2015;46:41921. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. This system allows the classification of comminuted femoral condyle fractures. Allmann KH, Altehoefer C, Wildanger G, et al. Injury 2011;42:14958. Rosenberg NJ. Zhou S, Cai M, Huang K. Treatment of. You may search for similar articles that contain these same keywords or you may At present, open reduction is often used to treat osteochondral fractures. [21]. your express consent. Soft tissues are retracted to . Sahu RL, Gupta P. Operative management of, [44]. The patient felt pain in his right knee and limited movement. Redislocation in 37/75 patients followed for 6-24 years. [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. [3]. The site is secure. [33]. Unauthorized use of these marks is strictly prohibited. Rofo. Unicondylar femoral fractures: therapeutic strategy and long-term results. [38]. Med Sci Monit, 2012, 18: CS117CS120. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. 1986;14:11720. 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. Primary traumatic patellar dislocation. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. However, some patients had suture removal during the second arthroscopy because of suture irritation. J Bone Joint Surg Am 2008;90:46370. This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). The distal femur is where the bone flares out like an upside-down funnel. Miyamoto R, Fornari E, Tejwani NC. -, Patel JM, Saleh KS, Burdick JA, Mauck RL. 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. Intraoperative, [12]. Objective: To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. Iwai T, Hamada M, Miyama T, et al. Screw insertion direction differs among operative approaches. 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. [92]. Osteochondral injury after acute patellar dislocation in children and adolescents. J Knee Surg 2008;21:23540. 2001;17:5425. This site needs JavaScript to work properly. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. [100]. (B) The suture of the lateral condyle of the femur is still fixed on the surface. 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. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. This article reviews the mechanism, diagnosis, classification, and treatment of Hoffa fractures. Friederichs MG, Greis PE, Burks RT. [3,4] In 1888, Hoffa described coronal fracture of the femoral condyle but did not indicate the source of the previous reference. Hoffa fracture with cruciate ligament, lateral collateral ligament, or meniscus injuries can be treated with arthroscopic surgery,[90] which has the advantages of minimal invasion, less of an effect on blood supply, early postoperative return to functional exercise, and effective prevention of nonunion and joint stiffness. Arthroscopy. Intertrochanteric femoral fractures occur mostly in the elderly, and the average age of onset is 66-76 years. Nonunion of a, [62]. Medicine 2022;101:50(e32104). Non-union coronal fracture femoral condyle, sandwich technique: a case report. modify the keyword list to augment your search. -. J Clin Orthop Trauma 2014;5:3841. Acta Orthop Scand 1997;68:4246. Other structures may be fractured at the same time due to the great forces experienced through the femur bones. J Orthop Trauma 1994;8:1426. AIMER was located at the outlet of the medial bone canal of the lateral condyle of the femur, and the HANDLE was adjusted to a suitable angle (5060). 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. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. Intra-articular corrective osteotomy for malunited. Recently, impaction fractures in the non-weight-bearing area of the lateral femoral condyle were reported in 16 of 6600 patients who underwent knee MRI. For example, a fracture line dividing the femoral condyle surface into 2 parts is classified as type I; 2 fracture lines dividing the femoral condyle surface into 3 parts is type II; and 3 or more fracture lines dividing the femoral condyle surface into 4 or more parts is type III. Arthroscopy 2012;28:13817. [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. [101]. [59]. Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. [83]. [4]. Epub 2018 Oct 4. Li et al[25] used absorbable suture to treat OCF caused by patellar dislocation and achieved good medium-term results. 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. [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. Moreover, even if the medial patellar retinaculum is strengthened, the patient still has symptoms such as anterior knee pain. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. Busam ML, Provencher MT, Bach BR. lateral femoral condyle fractures in 80% Angiography indications ankle-brachial index (ABI) <0.9 obvious signs of vascular injury i.e., hard and soft signs (pulselessness, rapidly expanding hematoma, massive bleeding, etc.) 2017;84:4417. Palmu S, Kallio PE, Donell ST, et al. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. Lateral-view radiograph of the left knee demonstrating an abnormally deep depression of the medial condylopatellar sulcus (arrow). Tong W, Yang J, Xu PL, et al. 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. Rev Chir Orthop Reparatrice Appar Mot. Bookshelf Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. 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 . According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. Springerplus 2016;5:1164. An unusual fracture of the lateral femoral condyle in a child. Knee Surg Sports Traumatol Arthrosc. J Bone Joint Surg Br 1989;71:11820. 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 McCarthy JJ, Parker RD. 1982;68:31725. Goel A, Sabat D, Agrawal P. Arthroscopic-assisted fixation of, [13]. http://creativecommons.org/licenses/by-nc-nd/4.0. The patient was evaluated by the physical therapist 2 days after his injury. (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. Shah JN, Howard JS, Flanigan DC, et al. Chin J Traumatol 2011;14:1436. to maintaining your privacy and will not share your personal information without

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