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. Lian X, Zeng YJ. 2020 Jun 15;9 (6):e823-e828. Bethesda, MD 20894, Web Policies [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. 2013;185:61120. Before Based on plate position, screws can be combined with a lateral antigliding plate[84] or a posterior antigliding plate.[55,87]. 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. 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. -, Patel JM, Saleh KS, Burdick JA, Mauck RL. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. 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. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. government site. [3]. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. The distal femur is the area of the leg just above the knee joint. Life (Basel). 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. [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. Technique for Treatment of Subchondral Compression Fracture of the You may search for similar articles that contain these same keywords or you may After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Wolters Kluwer Health The patellar height was in the normal range (Caton-Deschamp index 1.0). [9] The pain due to these combined injuries often exceeds that caused by the Hoffa fracture, which can lead physicians to miss the latter. Tsai CH, Hsu CJ, Hung CH, et al. Three types of fracture are defined based on the coronal fracture line (Fig. Distal pulses and sensation were intact. A patella that is stuck between the tibia and femur can be relocated naturally by flexing of the hip joint with the knee in 110 of flexion under local anesthesia. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. Bicondylar. Somford MP, van Ooij B, Schafroth MU, et al. [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. 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). Zeebregts CJ, Zimmerman KW, ten Duis HJ. Data is temporarily unavailable. chauffeur fracture: intraarticular fracture involving radial styloid; Another type of distal radius fracture is the Lister's tubercle fracture. The patient had no previous history of patella dislocation and pain around the knee. 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. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. Surgically treated Hoffa Fractures with poor long-term functional results. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. Operative, [46]. [97]. [42]. For bicondylar fractures, a median parapatellar incision can be used. Onay T, Glabi D, olak , et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. Wang JY, Liu Y, Li Y, et al. [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. Type 2 fractures require a . [47]. [23]. Sanders TG, Paruchuri NB, Zlatkin MB. 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. CT examination 6months after operation: one screw internal fixation, regular external condyle cortex, good alignment at the end of fracture, callus growth and unclear fracture line could be seen in the right lateral femoral condyle. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. Ul Haq R, Modi P, Dhammi I, et al. Lee et al[13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. 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. 2014;22:238895. Knee 2004;11:1257. An official website of the United States government. Miyamoto R, Fornari E, Tejwani NC. [61]. Materials and methods: This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. [72]. White EA, Matcuk GR, Schein A, et al. Conjoint bicondylar, [22]. 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. Lee SY, Niikura T, Iwakura T, et al. Conjoint bicondylar, [45]. Please try again soon. The exposed fracture line is initially fixed with a k-wire and screws are placed perpendicular to the fracture surface. Internal fixation with lag screws plus an antigliding plate for the, [88]. The term comminuted fracture refers to a bone that is broken in at least two places. The specific mechanism of a Hoffa fracture is not well understood. An attempt to treat Hoffa fractures under arthroscopy: A case report. An unusual fracture of the lateral femoral condyle in a child. Jabalameli M, Bagherifard A, Hadi H, et al. Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. [89]. Would you like email updates of new search results? Highlight selected keywords in the article text. According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. 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. your express consent. In these fractures, the popliteus tendon and the lateral head of the gastrocnemius muscle remain attached to the fragment. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. Busam ML, Provencher MT, Bach BR. Ostermann PA, Neumann K, Ekkernkamp A, 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. Potini VC, Gehrmann RM. [78]. 2017;84:4417. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). Clinical outcomes after absorbable suture fixation of patellar, [26]. Cartilage. Technique for Treatment of Subchondral Compression Fracture of the [4]. 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. Orbital blow-out fracture | Radiology Reference Article | Radiopaedia.org Wolters Kluwer Health 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. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. J Knee Surg. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. Dejour H, Walch G, Nove-Josserand L, et al. 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 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.) [52] This fact reminds us that a Hoffa fracture evaluation should be a routine part of the lower-limb and pelvis examination with or without injury. (A) The fresh 1.5cm1.5cm fracture surface of the lateral condyle of femur was found under arthroscopy. modify the keyword list to augment your search. Repair of displaced partial articular fracture of the distal femur: the. Intra-operative fractures in primary total knee arthroplasty - a [19]. However, Gavaskar et al[2] argued that no evidence confirms this correlation. 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 . Screw insertion direction differs among operative approaches. (C) CT examination of the left knee joint: the continuity of the subarticular bone of the lateral condyle of the left femur was interrupted. [21,22], In some patients, a Hoffa fracture is associated with a patellar fracture. A case report. Humerus Fracture: Types, Symptoms & Treatment - Cleveland Clinic Arastu MH, Kokke MC, Duffy PJ, et al. [7]. 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]. [4]. A 15-year-old female student accidentally sprained her right knee while participating in sports activities. FIGURE 1. Other structures may be fractured at the same time due to the great forces experienced through the femur bones. Xray examination of right knee joint: free bone mass can be seen at the anterior edge of the femur in the knee joint. Letenneur J, Labour PE, Rogez JM, et al. McDonough PW, Bernstein RM. Apropos of 128 cases]. 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. Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. [93]. (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. For Letenneur II and some Letenneur III fractures close to the posterior cortex of the femoral condyle, cannulated lag screw fixation is commonly used. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. [2]. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. 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. [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. Acta Orthop Traumatol Turc 2014;48:3837. Open bicondylar, [23]. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. Jarit GJ, Kummer FJ, Gibber MJ, et al. The distal femur is where the bone flares out like an upside-down funnel. Intraoperative, [12]. [76]. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. Baker BJ, Escobedo EM, Nork SE, et al. Keywords: Int Orthop 2015;39:124550. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. Bookshelf A modified posterolateral approach for. For more information, please refer to our Privacy Policy. Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. [65]. Some error has occurred while processing your request. J Orthop Trauma 2002;16:17881. The natural history. [48]. 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.. [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. Lewis SL, Pozo JL, Muirhead-Allwood WF. Making the diagnosis of a Hoffa fracture is challenging. The white arrow indicate the defect area. [22]. 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. For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. 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. [8]. Lateral radiographs of the affected knee were inspected for a . eCollection 2021 Jan. Uimonen MM, Repo JP, Huttunen TT, Nurmi H, Mattila VM, Paloneva J. Knee Surg Sports Traumatol Arthrosc. may email you for journal alerts and information, but is committed Data is temporarily unavailable. Medicine 2022;101:50(e32104). The https:// ensures that you are connecting to the (A) One 1.5mm Kirschner wire temporarily fixed the fracture block of the lateral condyle of the femur. [7,10] The finding of medial or lateral stress test and anterior and posterior drawer test were reported to be positive in some patients. 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. At present, open reduction is often used to treat osteochondral fractures. [21]. Nork SE, Segina DN, Aflatoon K, et al. (B) 1.5cm1.5cm free bone was found in the knee joint cavity, and the bone fracture was intact. Rev Chir Orthop Reparatrice Appar Mot. [53,91] However, some Hoffa fractures combined with a tear of the posterolateral horn of the lateral meniscus are identified intraoperatively, and tear of the lateral meniscus can be repaired with suture anchors. [10]. Matthewson MH, Dandy DJ. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. 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. [60]. 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. (C) The free edge of the anterior foot of the meniscus was rough (degree I). J Orthop Trauma 2006;20:2736. 5 and 6), and the lysholm score was 95 points, which was very good. Injury, 2005, 36: 862865. [100,101] To avoid damaging the cartilage in these cases, it is important to reduce the patella early and restore the patellofemoral joint stability by repairing the damaged medial soft tissues.
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