impaction fracture lateral femoral condyle treatment

Acta Biomater, 2019, 93:222238. Vivek T, Saubhik Da, Sahil G, et al. [20]. -. [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. Knee Surg Sports Traumatol Arthrosc. [29]. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. -, Patel JM, Saleh KS, Burdick JA, Mauck RL. Smith EJ, Crichlow TP, Roberts PH. Two cartilage masses can be seen during the operation. [Treatment of extensive chondral defects of the patella after patellar dislocation]. [25]. [31]. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with official website and that any information you provide is encrypted Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. [1]. 1994;2:1926. Singh AP, Dhammi IK, Vaishya R, 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. 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. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. Heuschen UA, Gohring U, Meeder PJ. [5]. Tripathy SK, Aggarwal A, Patel S, et al. Atesok K, Doral MN, Whipple T, et al. Buttress plating for a rare case of comminuted medial condylar. Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fractures--a prospective review of 18 patients. Fractures of the distal femur typically occur in the axial and sagittal planes. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [80]. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. Impaction fracture of the medial femoral condyle - PubMed Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Sharath RK, Gadi D, Grover A, et al. 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. Liebergall M, Wilber JH, Mosheiff R, et al. 2021 Jan 26;9(1):2325967120974649. doi: 10.1177/2325967120974649. 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. Arthroscopy 1996;12:2247. McDonough PW, Bernstein RM. Lee et al[13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. [6]. J Pediatr Orthop. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. [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. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. Introduction. [23]. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). [93]. Ostermann PA, Neumann K, Ekkernkamp A, et al. Difficulties involved in the Hoffa fractures [in German]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Federlin M, Krifka S, Herpich M, et al. Jabalameli M, Bagherifard A, Hadi H, et al. Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. 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. The .gov means its official. 5 and 6), and the lysholm score was 95 points, which was very good. The patellar height was in the normal range (Caton-Deschamp index 1.0). [19]. [74]. 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. [40]. 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. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. 2020 Jun 15;9 (6):e823-e828. [43]. J Knee Surg. Am J Sports Med 2008;36:37994. Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors. [60]. Zeebregts CJ, Zimmerman KW, ten Duis HJ. Arthroscopic. J Bone Joint Surg Am 2008;90:46370. This site needs JavaScript to work properly. A case of distal femur medial condyle Hoffa type II(C) fracture treated with headless screws. View Large Image Download Hi-res image Download (PPT) The distal femur is where the bone flares out like an upside-down funnel. The most common way to fracture the femoral condyles is jumping from a large height. [41]. After arthroscopic confirmation of Lateral Femoral Condyle (LFC) ostechondral fracture (HSL, Hill-Sachs-like Lesion) the anterolateral portal is enlarged to 2-3 cm. [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. 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. 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. Palmu S, Kallio PE, Donell ST, et al. 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. [61]. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. Li R, Guo G, Chen B, Zhu L, Lin A. Arthroscopicallyassisted reduction and fixation of an old osteochondral fracture of the lateral femoral condyle. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. Acta Orthop Traumatol Turc 2014;48:3837. [56]. Radiographs of knee joint show loose body in joint. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. Efficacy of multiple Acutrak hollow head compression screws in the, [68]. Seeley MA, Knesek M, Vanderhave KL. After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. Sanders TG, Paruchuri NB, Zlatkin MB. [98]. Fracture of the Femoral Condyles - Physio.co.uk [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]. Gelber PE, Erquicia J, Abat F, et al. Jain A, Agrawal P, Chadha M, et al. [18]. [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. [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. 2007 Oct;23(10):1133.e1-4. Operative. 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 . Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. The patient was referred to an or- thopaedic surgeon, who recommended conservative management. We report a case of patellar dislocation with OCF in the weight-bearing area of LFC. The natural history. Epub 2018 Oct 4. The tears of the lateral meniscus and medial meniscus were detected during arthroscopy. 2007;41 Suppl 2:105-12. After 1 year follow-up, good functional and radiographic outcome were obtained. [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. Lal H, Bansal P, Khare R, et al. 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. 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. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. However, some patients had suture removal during the second arthroscopy because of suture irritation. 2017;84:4417. National Library of Medicine [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. J Clin Orthop Trauma 2015;6:4650. Some error has occurred while processing your request. Patellar dislocation with OCF in weight-bearing area of LFC is a rare injury in adolescents. Distal Femur (Thighbone) Fractures of the Knee - OrthoInfo - AAOS Wang JY, Liu Y, Li Y, et al. [37]. Medicine (Baltimore). Ercin E, Bilgili MG, Basaran SH, et al. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. Arthroscopic management of a posterior femoral condyle (Hoffa) fracture: surgical technique. J Orthop Trauma 1994;8:1426. The distal femur is the area of the leg just above the knee joint. 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.. Careful consideration and attention to the principles of fracture management, and the role of the condyle as an articulating . [99]. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. In reviewing left knee radiographs that had previously been interpreted as normal, the physical therapist noted an abnormally deep depression of the medial condylopatellar sulcus, which was concerning for a possible impacted osteochondral fracture. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. This method is beneficial for reducing small and rotating fragments. A comparison of the clinical effect of two fixation methods on Hoffa fractures. Osteochondral fractures of the lateral. In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. Friederichs MG, Greis PE, Burks RT. Authors Comminuted fractures are caused by severe traumas like car accidents. [38]. Marzouki A, Zizah S, Benabid M, et al. Wagih AM. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . What is an Impact Fracture? - Definition from Corrosionpedia chauffeur fracture: intraarticular fracture involving radial styloid; Another type of distal radius fracture is the Lister's tubercle fracture. Keyword Highlighting Unauthorized use of these marks is strictly prohibited. Open bicondylar, [23]. The patient had an uneventful postoperative recovery. (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. 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. Osteochondral fracture (OCF) in weight-bearing area of lateral femoral condyle (LFC) is a rare combined injury caused by patellar dislocation. 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. Type 2 fractures require a . [7]. Data is temporarily unavailable. Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. In the AO classification, Hoffa fracture is classified as type B3.2. [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. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. Emerg Radiol 2015;22:3378. In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. (A) Use of anterior cruciate ligament locator to assist drilling at the distal end of the femur. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. The patient was evaluated by the physical therapist 2 days after his injury. [94]. Technique for Treatment of Subchondral Compression Fracture of the Bone Joint J 2013;95-B:116571. 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). Hingelbaum S, Best R, Huth J, et al. 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. The goals of treatment include restoration of function and esthetics. The risk of blood vessel damage when using this approach is minimal but the common peroneal nerve should be isolated first. sharing sensitive information, make sure youre on a federal [11,12] The bone marrow edema at the posterolateral aspect of the LFC suggest that the knee joint is highly flexed during patellar dislocation. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. Introduction. 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 Keywords: Abstract Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [8]. Hoffa nonunion, two cases treated with headless compression screws. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. In general, there has been a trend toward . The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. Redislocation in 37/75 patients followed for 6-24 years. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with Careers. [90]. Arthroscopy. Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. J Knee Surg 2013;26(Suppl 1):S8993. Hawkins et al[18] found that the recurrent dislocation rate of patients with primary patellar dislocation is related to congenital femoral trochlear dysplasia, high patellar position and large TT-TG. J Orthop Surg Res 2012;7:21. Repair of displaced partial articular fracture of the distal femur: the. Open reduction and internal fixation are preferred. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. Ercin E, Baca E, Kural C. Arthroscopic. 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. [22]. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion.
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