Pathology. In these fractures, the popliteus tendon and the lateral head of the gastrocnemius muscle remain attached to the fragment. Lal H, Bansal P, Khare R, et al. [15]. Incarcerated patellar tendon in. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. [7]. Skeletal Radiol 2015;44:3743. Sun H, He QF, Huang YG, et al. 2007 Oct;23(10):1133.e1-4. Werner BC, Miller MD. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. Letenneur J, Labour PE, Rogez JM, et al. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. Unfallchirurg 2004;107:1521. -, Biau DJ, Schranz PJ. 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. 2001;17:5425. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Jarit GJ, Kummer FJ, Gibber MJ, et al. [39]. [20]. Operative, [46]. [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. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. 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. Please try again soon. [23]. The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request. [7] The development of trochlear sulcus of femur was classified as type A according to Dejour et al,[8] and the TT-TG[9] was 15mm. . Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. Our hospital's institutional review board waived the need for ethical approval for this review paper. Surgical, [71]. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. Highlight selected keywords in the article text. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. Cureus 2016;8:e802. Management of any globe injury generally takes precedence over fractures 1. Radiography can reveal fracture lines. The distal femur is the area of the leg just above the knee joint. [42]. [61]. [25] A cannulated screw combined with a plate is recommended in these cases. 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 . Postoperative reexamination of computed tomography scan showed that the bone block was well reduced. Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. Please enable scripts and reload this page. [103]. 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. modify the keyword list to augment your search. [2]. 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. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. chauffeur fracture: intraarticular fracture involving radial styloid; Another type of distal radius fracture is the Lister's tubercle fracture. [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. A lateral incision plus Gerdy tubercle osteotomy provides full exposure[68] especially in cases of coronal fracture of the lateral condyle. d Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Zhejiang, China. [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. Medicine 2022;101:50(e32104). Transverse Hoffas or deep. Posterior wall blowout in anterior cruciate ligament reconstruction: avoidance, recognition, and salvage. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. [6]. 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). Soraganvi PC, Narayan Gowda B, Rajagopalakrishnan R, et al. Please try after some time. [4]. A swashbuckler approach[34,72] can be used to treat bicondylar Hoffa fractures because it protects the Quadriceps femoris abdomen during surgery, allowing quick postoperative recovery of muscle strength and range of motion. 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. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. Internal fixation with lag screws plus an antigliding plate for the, [88]. J Orthop Trauma 1994;8:1426. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. 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. [66]. [40]. A rare case of unicondylar medial, [24]. Orthop J Sports Med. [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. Moreover, even if the medial patellar retinaculum is strengthened, the patient still has symptoms such as anterior knee pain. Lewis SL, Pozo JL, Muirhead-Allwood WF. In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. Medicine101(50):e32104, December 16, 2022. In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. Radiographs of knee joint show loose body in joint. Based on plate position, screws can be combined with a lateral antigliding plate[84] or a posterior antigliding plate.[55,87]. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. In the AO classification, Hoffa fracture is classified as type B3.2. Unable to load your collection due to an error, Unable to load your delegates due to an error. Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. Bioactive factors for cartilage repair and regeneration: improving delivery, retention, and activity. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. may email you for journal alerts and information, but is committed Orthopedics, 2016, 39: e362e366. Coronal fractures of the lateral femoral condyle. Screw insertion direction differs among operative approaches. Liebergall M, Wilber JH, Mosheiff R, et al. In these cases, magnetic resonance imaging (MRI) can show a lateral femoral notch sign: a depression in the lateral femoral condyle, which could indicate an ACL tear . 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. Methods All patients with post-injury bi-plane radiographs and MRI images after sustaining a tear to the anterior cruciate ligament were included. eCollection 2021 Jan. Uimonen MM, Repo JP, Huttunen TT, Nurmi H, Mattila VM, Paloneva J. Knee Surg Sports Traumatol Arthrosc. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. Keywords: [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. Jain A, Agrawal P, Chadha M, et al. Sharath RK, Gadi D, Grover A, et al. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. patellar margin thus corresponding to impaction injuries. 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. An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. This is the first report on a fracture of medial femoral condyle treated with this implant. 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. Acta Orthop Scand 1997;68:4246. An official website of the United States government. Busam ML, Provencher MT, Bach BR. Highlight selected keywords in the article text. [78]. Unauthorized use of these marks is strictly prohibited. Calmet J, Mellado JM, Garcia Forcada IL, et al. [Treatment of extensive chondral defects of the patella after patellar dislocation]. Oral application of Qiangguyin Keli and alendronate sodium vitamin D3 tablets in postoperative anti-osteoporosis. For Letenneur II and some Letenneur III fractures close to the posterior cortex of the femoral condyle, cannulated lag screw fixation is commonly used. [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. [65]. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. [8]. 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%. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. Please enable it to take advantage of the complete set of features! Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature. Arthroscopic-assisted fixation of. [82,83] A biomechanical study by Li et al[84] demonstrated that plates combined with screws more firmly fixed the femoral condyle, reducing the probability of fracture displacement. Above: Therapist performing soft tissue massage on the patella and surrounding connective tissue. 1). [93]. [92] Moreover, if soft tissue embedded within the fracture line prevents reduction, arthroscopy can distinguish the tissues and the degree of damage to assist restoration. 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. 1). Epub 2018 Oct 4. If fractures are present they are usually associated with orbital rim or other significant craniofacial injuries. -. [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. Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. This method is also recommended for patients with osteoporosis, metaphyseal extension, or comminuted Hoffa fractures. 1996 ). [43] If radiographic examination is not diagnostic but a Hoffa fracture is suspected, a CT scan, which is the gold standard for diagnosis of a Hoffa fracture, should be performed. Nonunion of a. 2007;41 Suppl 2:105-12. 1994;2:1926. 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. Federlin M, Krifka S, Herpich M, et al. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Arthrosc Tech 2015;4:e299303. Background The goal of this present study was to precisely determine the dimension and location of the impaction fracture on the lateral femoral condyle in patients with an ACL rupture. 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). However, some patients had suture removal during the second arthroscopy because of suture irritation. Choudhary RK, Tice JW. [53]. Preliminary X-ray examination showed osteochondral defects of LFC and loose body in knee joint (Fig. Fracture and dislocation compendium: Orthopaedic Trauma Association Committee for Coding and, [35]. Allmann KH, Altehoefer C, Wildanger G, et al. The Authors. Complained of swelling and pain of the right knee after spraining during sports activities, demonstrated painful limited motion. [105]. * Correspondence: Lijiang He, Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Hangzhou, Zhejiang 311121, China (e-mail: [emailprotected]). [5]. Neglected. Am J Sports Med 2008;36:37994. 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 funding and conflicts of interest to disclose. 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]. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. You may be trying to access this site from a secured browser on the server. Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. 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. Heuschen UA, Gohring U, Meeder PJ. 4). 2022 Dec 16;101(50):e32104. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. Type 2 fractures require a . Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. The goals of treatment include restoration of function and esthetics. 2013;37:238594. Ercin E, Bilgili MG, Basaran SH, 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. [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. (B) 1.5cm1.5cm free bone was found in the knee joint cavity, and the bone fracture was intact. The natural history. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. 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). Conjoint bicondylar, [45]. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Federal government websites often end in .gov or .mil. Bali K, Mootha AK, Krishnan V, et al. 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. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. [79]. Fixation with headless screws can reduce the degree of cartilage injury. Difficulties involved in the Hoffa fractures [in German]. MRI of osteochondral defects of the lateral, [3]. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. [5-9] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Operative. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. (C) CT examination of the left knee joint: the continuity of the subarticular bone of the lateral condyle of the left femur was interrupted. Rue JP, Busam ML, Detterline AJ, et al. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Westmoreland GL, McLaurin TM, Hutton WC. 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 . Arthroscopy 1996;12:2247. The patellar height was in the normal range (Caton-Deschamp index 1.0). Arthroscopy. Plate fixation for Letenneur type I. 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. PMC At present, open reduction is often used to treat osteochondral fractures. The functional and radiographic outcome were satisfactory at 18 months after operation.

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