[78]. [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. Tripathy SK, Aggarwal A, Patel S, et al. [58]. Open reduction and internal fixation are preferred. Open bicondylar, [23]. Injury 2011;42:14958. 2017;84:4417. Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature. Arthroscopic. Bethesda, MD 20894, Web Policies On lateral radiographs, the normal femoral condyles overlap, and bone cortex interruption may not be visible. 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%. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: Reduce Pain Restore Movement Optimise Recovery What are Femoral Condyle Fractures? Gesslein M, Merkl C, Bail HJ, et al. In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. [50]. normal vital signs. 3). Malunion: This happens when your broken bones don't line up correctly while they heal. Acta Chir Orthop Traumatol Cech. The injury to MCL was also observed with MRI. J Knee Surg. Callewier A, Monsaert A, Lamraski G. Lateral. Search for Similar Articles Epub 2018 Oct 4. J Orthop Trauma 2006;20:2736. to maintaining your privacy and will not share your personal information without [66]. (B) The suture of the lateral condyle of the femur is still fixed on the surface. 2017;30:37884. Am J Sports Med. Ostermann PA, Neumann K, Ekkernkamp A, et al. For more information, please refer to our Privacy Policy. Transverse Hoffas or deep. Difficulties involved in the Hoffa fractures [in German]. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. Data is temporarily unavailable. 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. ;Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Hoffa nonunion, two cases treated with headless compression screws. Fractures of the distal femur typically occur in the axial and sagittal planes. 2001;17:5425. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. A rare case of unicondylar medial, [24]. 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). The patient was evaluated by the physical therapist 2 days after his injury. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. Gao M, Tao J, Zhou Z, et al. [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. Somford MP, van Ooij B, Schafroth MU, et al. A hip fracture is a break that occurs in the upper part of the femur (thigh bone). [18]. [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. [95]. The specific mechanism of a Hoffa fracture is not well understood. 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. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. Operative. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. Caton J, Deschamps G, Chambat P, et al. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. may email you for journal alerts and information, but is committed Li et al[25] used absorbable suture to treat OCF caused by patellar dislocation and achieved good medium-term results. Arthroscopic; Internal fixation; Osteochondral fracture; Suture anchor; TWINFIX Ti. 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. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. Sagittal, fat-suppressed, proton density-weighted magnetic resonance image of the left knee demonstrating a focal indentation of the anterior portion of the medial femoral condyle (orange arrow . Meyer C, Enns P, Alt V, et al. [36]. J Bone Joint Surg Am 2006;88:22704. Gerdy's tubercle osteotomy for the, [69]. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Acta Orthop Traumatol Turc. [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. Bookshelf Kapoor C, Merh A, Shah M, et al. Introduction. [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. Osteochondral fractures of the lateral. (B) BULLET fixed at the entrance of the lateral bone canal of the distal femur. Transverse Hoffa's or deep osteochondral fracture? Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. Gelber PE, Erquicia J, Abat F, et al. (A) The fresh 1.5cm1.5cm fracture surface of the lateral condyle of femur was found under arthroscopy. 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. eCollection 2021 Jan. Uimonen MM, Repo JP, Huttunen TT, Nurmi H, Mattila VM, Paloneva J. Knee Surg Sports Traumatol Arthrosc. Osteochondral injuries of the knee in pediatric patients. Conjoint bicondylar, [45]. Ann Chir 1978;32:2139. modify the keyword list to augment your search. Life (Basel). Iwai T, Hamada M, Miyama T, et al. -, Biau DJ, Schranz PJ. 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. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. (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. Nonunion of coronal shear fracture of femoral condyle. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. [9]. Soft tissues are retracted to . (B) AIMER was located at the outlet of the medial bone canal of the lateral condyle of the femur. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. Highlight selected keywords in the article text. You will need surgery to repair your bone, and recovery can take a year or longer. Matthewson MH, Dandy DJ. Knee 2004;11:1257. [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. [96,97] Thus, closed reduction is recommended when Hoffa fracture is accompanied by patella dislocation. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. Arthroscopic management of a posterior femoral condyle (Hoffa) fracture: surgical technique. Surgical, [71]. absorbable internal fixation; dislocation of patella; femoral condyle; osteochondral fracture. Braune C, Rehart S, Kerschbaumer F, Jger A. . Injury 2005;36:8625. [16]. Injury 1989;20:3714. 2). Antigliding plating for Letenneur type I Hoffa fractures. Ozturk A, Ozkan Y, Ozdemir RM. Arthroscopy 2011;27:81724. osteochondral impaction fracture postsurgical (e.g. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. You may be trying to access this site from a secured browser on the server. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. [93] The biggest challenge in the treatment of Hoffa fractures under arthroscopy due to the patella is dissecting the fragments for reduction[94] and placing screws perpendicularly into the fracture line. 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. Jabalameli M, Bagherifard A, Hadi H, et al. 2023 Jan;15(1):103-110. doi: 10.1111/os.13586. Cancellous screws cannot achieve adequate compression[55] and require more surgical time to countersink. J Orthop Surg Res 2012;7:21. Report of 20 cases [in French]. 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. Please try after some time. 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. Distal pulses and sensation were intact. 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. your express consent. Busam ML, Provencher MT, Bach BR. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. Many author think these injuries are caused by the impact between the patella and femoral condyle with a knee flexed over 90. Springerplus 2016;5:1164. J Orthop Trauma 1994;8:1426. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. Redislocation in 37/75 patients followed for 6-24 years. Keywords: Arthroscopy. J Bone Joint Surg Am 2008;90:46370. Clipboard, Search History, and several other advanced features are temporarily unavailable. However, if the tunnel is too close to the distal femoral articular surface and too little cartilage-covered bone is retained, either the passage of the tendon through the bone tunnel or fixation of the tendon can lead to a Hoffa fracture. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. 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. Fixation with headless screws can reduce the degree of cartilage injury. [80]. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Li WH, Li Y, Wang MY. See this image and copyright information in PMC. Vivek T, Saubhik Da, Sahil G, et al. [81] For patients who require a longer healing time, such as those with a higher body mass index or poor compliance, the simple application of a cannulated screw is insufficient to counter the great shearing force between condyles and the tibial plateau when the knee is in flexion. Arthroscopy 2012;28:13817. Zeebregts CJ, Zimmerman KW, ten Duis HJ. You may search for similar articles that contain these same keywords or you may Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. Chin J Traumatol. Previous article . 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. Bali K, Mootha AK, Krishnan V, et al. The most common way to fracture the femoral condyles is jumping from a large height. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. sharing sensitive information, make sure youre on a federal [19] Therefore, lateral condyle fracture is significantly more common than medial condyle 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). [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. In addition to changes in bone mineral composition and a reduced proportion of bone matrix in patients with osteoporosis, changes in bone microstructure, thinning of bone cortex, and reduction in the number and size of bone trabeculae result in a decreased bone load capacity[26] and an increased risk of a Hoffa fracture with low-energy trauma. 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. Shetty GM, Wang JH, Kim SK, et al. [104]. Zhou, Yabin MDa,b; Pan, Ying MDc; Wang, Qingxian MDa; Hou, Zhiyong MDa; Chen, Wei MDa,, aDepartment of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Orthopedic Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, bDepartment of Orthopedic Surgery, Shijiazhuang The Third Hospital. Sagittal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. PMC Bicondylar. 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. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. 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. Non-union coronal fracture femoral condyle, sandwich technique: a case report. 2018 Oct;21(5):308-310. doi: 10.1016/j.cjtee.2018.08.004. [90]. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Bioactive factors for cartilage repair and regeneration: improving delivery, retention, and activity. Arthrosc Tech 2015;4:e299303. At present, open reduction is often used to treat osteochondral fractures. Lian X, Zeng YJ. Wolters Kluwer Health (LTC, Lateral Tibial Condyle.) Mashoof AA, Scholl MD, Lahav A, et al. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. The term comminuted fracture refers to a bone that is broken in at least two places. Acta Orthop Traumatol Turc 2014;48:3837. Am J Sports Med 2008;36:37994. [85]. Rev Chir Orthop Reparatrice Appar Mot. 2007 Oct;23(10):1133.e1-4. Our hospital's institutional review board waived the need for ethical approval for this review paper. Tan et al[75] recommended an improved posterolateral approach starting from the space between the peroneal nerve and the biceps femoris. Arthroscopy-assisted, [55]. your express consent. The functional and radiographic outcome were satisfactory at 18 months after operation. 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. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). [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]. J Pediatr Orthop B, 2013, 22: 344349. This is the first report on a fracture of medial femoral condyle treated with this implant. 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. Orthopedics, 2016, 39: e362e366. Arthroscopy 1996;12:2247. Skeletal Radiol 2015;44:3743. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. [17]. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. Tan Y, Li H, Zheng Q, et al. For Letenneur II and some Letenneur III fractures close to the posterior cortex of the femoral condyle, cannulated lag screw fixation is commonly used. d Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Zhejiang, China. Please try after some time. Disclaimer. Research Article: Systematic Review and Meta-Analysis. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. 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. 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. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. [Treatment of extensive chondral defects of the patella after patellar dislocation]. Distal femur fractures most often occur either in older people whose bones . Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd. Xray examination of right knee joint: free bone mass can be seen at, (A) MRI examination of the right knee joint: the bone continuity at the, (A) The fresh 1.5 cm 1.5 cm fracture surface of the lateral, (A) One 1.5 mm Kirschner wire temporarily fixed the fracture block of the, (A) Use of anterior cruciate ligament locator to assist drilling at the distal, (A) Through the hollow needle channel of the femoral intercondylar fossa, the folding, Surgical diagrams (A: osteochondral fracture, Surgical diagrams (A: osteochondral fracture of the lateral femoral condyle; B: fixation of, CT examination 6 months after operation: one screw internal fixation, regular external condyle, (A) A blurred fracture line can be seen at the fracture of the, MeSH 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. [72]. [25]. [19]. Please enable scripts and reload this page. Pathology. Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. [103]. Radiography can reveal fracture lines. Medial and lateral buttressing may be required if either fracture extends proximally in the same plane. [21]. Chin J Traumatol 2011;14:1436. Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. The knee joint is placed in flexion during surgery,[65,66] placing the joint capsule and gastrocnemius in a relaxed state, which reduces the traction on the fracture and is conducive to fracture repair. [19]. Marzouki A, Zizah S, Benabid M, et al. Knee Surg Sports Traumatol Arthrosc. Letenneur J, Labour PE, Rogez JM, et al. [98]. However, the latest biomechanical study[88] showed that lateral antiglide plate has greater anti-shearing strength than posterior fixation. Appointments 216.444.2606. Paa L, Vesel R, Koi J, et al. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. 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. 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.

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