The distal femur is where the bone flares out like an upside-down funnel. Analysis of functional outcome of Hoffa fractures: a retrospective review of 32 patients. [65]. Arthroscopy 2011;27:81724. Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Min L, Tu CQ, Wang GL, et al. Please try after some time. [17,18] Magnetic resonance imaging (MRI) should be performed when injury is suspected to the meniscus, cruciate ligament, collateral ligament, or other soft tissues to determine the extent of injury,[32] develop appropriate surgical plans, and accurately assess prognosis. Careful consideration and attention to the principles of fracture management, and the role of the condyle as an articulating . Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. your express consent. Kapoor C, Merh A, Shah M, et al. 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. 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. J Bone Joint Surg Am 2005;87:5649. This method is beneficial for reducing small and rotating fragments. [100]. Radiographs of knee joint show loose body in joint. Please enable it to take advantage of the complete set of features! [21]. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. A case of distal femur medial condyle Hoffa type II(C) fracture treated with headless screws. Atesok K, Doral MN, Whipple T, et al. [82]. 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. 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. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). Knee Surg Sports Traumatol Arthrosc. (B) BULLET fixed at the entrance of the lateral bone canal of the distal femur. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. Sahu RL, Gupta P. Operative management of, [44]. [50]. At present, open reduction is often used to treat osteochondral fractures. [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. osteochondral impaction fracture postsurgical (e.g. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. MRI of osteochondral defects of the lateral, [3]. [3]. PMC With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. Operative, [46]. 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). Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Werner BC, Miller MD. National Library of Medicine [21]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Injury 2015;46:41921. Among the various types of Hoffa fractures, the Letenneur II is unique because the fragments are small and difficult to fix, and poor blood supply to the fragments impairs its healing. [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. Lian X, Zeng YJ. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. Long term results of unicondylar fractures of the femur. Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. 2). Fracture surgery complications include: Acute compartment syndrome (ACS): A build-up of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage. 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. Distal femur fractures most often occur either in older people whose bones . You may be trying to access this site from a secured browser on the server. [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. [74]. Highlight selected keywords in the article text. Type 2 fractures require a . Visual observation revealed significant right knee effusion and an inability to bear weight on the right lower extremity or flex his knee beyond 80. Would you like email updates of new search results? Biau DJ, Schranz PJ. The work cannot be changed in any way or used commercially without permission from the journal. Osteochondral fractures of the lateral, [11]. Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. 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]. 1996 ). Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. (A) One 1.5mm Kirschner wire temporarily fixed the fracture block of the lateral condyle of the femur. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. and transmitted securely. Open bicondylar, [23]. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. eCollection 2020 Jun. The Letenneur classification[31] divides fractures into 3 types (Fig. We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteen-year-old male with a positive history of significant weight gain of 5 kilograms in last six months. At present, open reduction is often used to treat osteochondral fractures. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. You may search for similar articles that contain these same keywords or you may 2022 Dec 16;101(50):e32104. In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. Tsai CH, Hsu CJ, Hung CH, et al. (B) The suture of the lateral condyle of the femur is still fixed on the surface. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Plate fixation for Letenneur type I. Hingelbaum S, Best R, Huth J, et al. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. An unusual fracture of the lateral femoral condyle in a child. [91]. Rev Chir Orthop Reparatrice Appar Mot. Smith EJ, Crichlow TP, Roberts PH. absorbable internal fixation; dislocation of patella; femoral condyle; osteochondral fracture. Fixation with headless screws can reduce the degree of cartilage injury. Medial and lateral buttressing may be required if either fracture extends proximally in the same plane. This approach can also be used to treat comminuted fractures or complex Hoffa fractures.[18]. Bioactive factors for cartilage repair and regeneration: improving delivery, retention, and activity. J Knee Surg. [2] This fracture type was 1st described by Busch in 1869. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. 2021;13(1_suppl):966S73S. Data is temporarily unavailable. Med Sci Monit, 2012, 18: CS117CS120. Dhillon MS, Mootha AK, Bali K, et al. Injury 2005;36:8625. Management of any globe injury generally takes precedence over fractures 1. [19] Therefore, lateral condyle fracture is significantly more common than medial condyle fracture. [58]. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. Z Orthop Ihre Grenzgeb. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. Allmann KH, Altehoefer C, Wildanger G, et al. Jiang YR, Wang ZY, Zhang DB, et al. Open reduction and internal fixation are preferred. 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. A hip fracture is a break that occurs in the upper part of the femur (thigh bone). [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. Ercin E, Baca E, Kural C. Arthroscopic. Chin J Orthop Trauma 2009;9:8503. Meyer C, Enns P, Alt V, et al. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. Monocondylar fractures of the femur: a review of 13 patients. The term comminuted fracture refers to a bone that is broken in at least two places. 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. Goel A, Sabat D, Agrawal P. Arthroscopic-assisted fixation of, [13]. The most common way to fracture the femoral condyles is jumping from a large height. 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. [18]. Busam ML, Provencher MT, Bach BR. Twenty-seven-year nonunion of a. The advantage of this approach is that it does not compromise future arthroplasty surgery; however, it does not allow visualization and treatment of any posterior comminution. The authors have no conflicts of interest to disclose. (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. 1). FIGURE 2. Marzouki A, Zizah S, Benabid M, et al. Arthrosc Tech 2015;4:e299303. [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. Matthewson MH, Dandy DJ. Arthroscopy 1996;12:2247. [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. 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. 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). After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. Difficulties involved in the Hoffa fractures [in German]. Westmoreland GL, McLaurin TM, Hutton WC. The patient was referred to an or- thopaedic surgeon, who recommended conservative management. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. Heuschen UA, Gohring U, Meeder PJ. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. 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. Hoffa fractures are caused by shear stress between the femoral condyle and tibial plateau. Keyword Highlighting [42] Compared with anteroposterior and lateral films, oblique radiographic views can show minimally displaced fractures better[14] and can, therefore, be used as a routine examination method for a Hoffa fracture. Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. Manfredini M, Gildone A, Ferrante R, et al. Highlight selected keywords in the article text. doi: 10.1016/j.eats.2020.02.016. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. [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]. 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 swashbuckler: a modified anterior approach for fractures of the distal femur. -, Morris John K, Weber Alexander E, Morris Mark S. Adolescent femoral chondral fragment fixation with polyLlactic acid chondral darts. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Xray examination of right knee joint: free bone mass can be seen at the anterior edge of the femur in the knee joint. [4]. Impact fractures are due to track formation and propagation. FIGURE 1. We used the key words Hoffa fracture and coronal fracture of femoral condyle for the knowledge. J Orthop Trauma 2002;16:17881. [16]. Letenneur J, Labour PE, Rogez JM, et al. Malunion: This happens when your broken bones don't line up correctly while they heal. Shetty GM, Wang JH, Kim SK, et al. Tong W, Yang J, Xu PL, et al. [59]. Liebergall M, Wilber JH, Mosheiff R, et al. Orthopedics, 2016, 39: e362e366. The patient had no previous history of patella dislocation and pain around the knee. [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]. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. Musculoskelet Surg 2012;96:4954. Injury 2011;42:14958. Epub 2020 Sep 18. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. [33]. Intra-articular corrective osteotomy for malunited. 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. Osteochondral fracture involving the weight-bearing portion of the lateral femoral condyle is relatively rare injury as it involves hyper flexion of the knee at the time of . 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. Tan Y, Li H, Zheng Q, et al. Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. You will need surgery to repair your bone, and recovery can take a year or longer. Ostermann PA, Neumann K, Ekkernkamp A, et al. J Bone Joint Surg Am 1974;56:4234. [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. Redislocation in 37/75 patients followed for 6-24 years. (C) The free edge of the anterior foot of the meniscus was rough (degree I). Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. Many author think these injuries are caused by the impact between the patella and femoral condyle with a knee flexed over 90. This article reviews the mechanism, diagnosis, classification, and treatment of Hoffa fractures. Irreducible, incarcerated vertical dislocation of patella into a. The site is secure. Radiography can reveal fracture lines. Incarcerated patellar tendon in. Wolters Kluwer Health [60]. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. may email you for journal alerts and information, but is committed The authors have no funding and conflicts of interest to disclose. [61]. A fracture is a broken bone. The natural history. Osteochondral fracture (OCF) in weight-bearing area of lateral femoral condyle (LFC) is a rare combined injury caused by patellar dislocation. 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. The patellar height was in the normal range (Caton-Deschamp index 1.0). . Seeley MA, Knesek M, Vanderhave KL. A review of 23 patients. 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. findings identifies vascular segments with diminished flow vascular injury [10] Werner and Miller [11] reported that iatrogenic injury is a cause of Hoffa fracture . -, Biau DJ, Schranz PJ. [94]. Rue JP, Busam ML, Detterline AJ, et al. 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. [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. 2003;19:71721. Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fractures--a prospective review of 18 patients. Onay T, Glabi D, olak , et al. Subchondral insufficiency fracture of the knee is not thought to be caused by bone death but instead by osteoporosis and insufficiency fractures, with histopathologically proven origins in weakened trabeculae and applied microtraumatic forces 6,13. [84]. [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. [30]. ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. 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. Jain A, Agrawal P, Chadha M, et al. In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. Appointments 216.444.2606. 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. J Knee Surg 2013;26(Suppl 1):S8993. Acta Orthop Scand 1997;68:4246. Jabalameli M, Bagherifard A, Hadi H, et al. [20]. When the patient was sent to the emergency room, the right knee swelled obviously, tenderness over the medial border of the patella, the apprehension test was positive, lateral stress test was negative, and the knee range of motion:F/E 90/0. (B) AIMER was located at the outlet of the medial bone canal of the lateral condyle of the femur. View Large Image Download Hi-res image Download (PPT) J Bone Joint Surg Am 2008;90:46370. A lateral incision plus Gerdy tubercle osteotomy provides full exposure[68] especially in cases of coronal fracture of the lateral condyle. 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. [75]. This system allows the classification of comminuted femoral condyle fractures. Bilateral. J Pediatr Orthop B, 2013, 22: 344349. J Pediatr Orthop. 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. Springerplus 2016;5:1164. [3,4] In 1888, Hoffa described coronal fracture of the femoral condyle but did not indicate the source of the previous reference. Medicine (Baltimore). [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. For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. [40]. After the incision was closed in layers, the lower limb was splinted for 6 weeks, isometric exercises for the quadriceps began the day after surgery. Arastu MH, Kokke MC, Duffy PJ, et al. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Some patellar dislocations are difficult to treat with closed reduction because the patella is attached to the intercondylar fossa by the quadriceps femoris[98] and rotational or vertical displacement is present. Please try again soon. [19]. Bartonicek J, Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. http://creativecommons.org/licenses/by-nc-nd/4.0. 2007;41 Suppl 2:105-12. 2013;185:61120. 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.) Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. [13] There are also many reports on OCF in non-weight-bearing area of LFC. [101]. Suture anchor system is mostly used to repair rotator cuff and patellar tendon. Gelber PE, Erquicia J, Abat F, et al. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. [89]. Epub 2018 Oct 4. 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. 1). J Bone Joint Surg Am 2006;88:22704. You may be trying to access this site from a secured browser on the server. [22]. Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. [7]. [9]. [20]. In general, there has been a trend toward . Bone Joint J 2013;95-B:116571. Gesslein M, Merkl C, Bail HJ, et al.
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