impaction fracture lateral femoral condyle treatment

Open reduction and internal fixation are preferred. Gao et al[70] reported a medial to medial-posterior distal femur approach in which the fragments were exposed through the interval space between the gracilis muscle and medial head of the gastrocnemius and the medial collateral ligament can be clearly exposed and protected. Sun H, He QF, Huang YG, et al. modify the keyword list to augment your search. 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 . Tripathy SK, Aggarwal A, Patel S, et al. Appointments 216.444.2606. With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. Z Orthop Ihre Grenzgeb. J Orthop Trauma 2006;20:2736. Neglected. Rofo. [83]. 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. Ul Haq R, Modi P, Dhammi I, et al. For bicondylar fractures, a median parapatellar incision can be used. [85]. [18]. Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. Published by Wolters Kluwer Health, Inc. [98]. A patient, 15-year-old, female student. Malunion: This happens when your broken bones don't line up correctly while they heal. [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. J Bone Joint Surg Am 2006;88:22704. Tong W, Yang J, Xu PL, et al. Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. Transverse Hoffa's or deep osteochondral fracture? Distal femur fractures most often occur either in older people whose bones . Palmu S, Kallio PE, Donell ST, et al. Before A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. Report of 20 cases [in French]. For simple lateral condylar Hoffa fractures, a patellar anterolateral approach is most commonly used. [37]. Your message has been successfully sent to your colleague. On lateral radiographs, the normal femoral condyles overlap, and bone cortex interruption may not be visible. [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. You may search for similar articles that contain these same keywords or you may [41]. 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 association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. [11,12] The bone marrow edema at the posterolateral aspect of the LFC suggest that the knee joint is highly flexed during patellar dislocation. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Keyword Highlighting Friederichs MG, Greis PE, Burks RT. [79]. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. Dejour H, Walch G, Nove-Josserand L, et al. 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. Methods All patients with post-injury bi-plane radiographs and MRI images after sustaining a tear to the anterior cruciate ligament were included. 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. Soni A, Sen RK, Saini UC, et al. Subchondral insufficiency fracture of the knee: a non-traumatic injury [2] This fracture type was 1st described by Busch in 1869. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. [31]. Visual observation revealed significant right knee effusion and an inability to bear weight on the right lower extremity or flex his knee beyond 80. Knee 2004;11:1257. [53]. -, Morris John K, Weber Alexander E, Morris Mark S. Adolescent femoral chondral fragment fixation with polyLlactic acid chondral darts. Three types of fracture are defined based on the coronal fracture line (Fig. Medial and lateral buttressing may be required if either fracture extends proximally in the same plane. J Orthop Trauma 1994;8:1426. 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. Knee Surg Sports Traumatol Arthrosc 2011;19:3209. [80] From a biomechanical point of view, when the load is in the vertical direction, posteroanterior screw placement has a lower risk of shifting than anteroposterior placement. Femoral Condyle Fractures are a painful condition which can result from trauma injuries to the thigh bone and/or knee. Fractures of the distal femur typically occur in the axial and sagittal planes. Medicine101(50):e32104, December 16, 2022. (B) BULLET fixed at the entrance of the lateral bone canal of the distal femur. to maintaining your privacy and will not share your personal information without Type III is an oblique fracture of the femoral condyle with the fracture line located anterior to the joint capsule, anterior cruciate ligament, lateral collateral ligament, popliteal tendon, and the lateral head of the gastrocnemius muscle. 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. HHS Vulnerability Disclosure, Help Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. In this paper, three cases of osteochondral fracture of lateral femoral condyle were treated with arthroscopic TWINFIX Ti suture anchor internal fixation, and good results were obtained. Postoperative reexamination of computed tomography scan showed that the bone block was well reduced. Injury 2015;46:41921. Antigliding plating for Letenneur type I Hoffa fractures. Introduction. 2021;13(1_suppl):966S73S. Sanders TG, Paruchuri NB, Zlatkin MB. 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. Please enable scripts and reload this page. Rosenberg NJ. Distal Femur Fractures - Trauma - Orthobullets 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. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Chin J Traumatol 2011;14:1436. J Knee Surg. Ostermann PA, Neumann K, Ekkernkamp A, et al. Onay T, Glabi D, olak , et al. The anatomical plate for distal medial condyle fracture of femur should be developed as soon as possible. The funding sources have no role in study design, literature collection, review, data analysis, and manuscript preparation. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. A fracture is a broken bone. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. 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). Marzouki A, Zizah S, Benabid M, et al. 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. 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. Intraoperative, [12]. Somford MP, van Ooij B, Schafroth MU, et al. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. 2007 Oct;23(10):1133.e1-4. Technique for Treatment of Subchondral Compression Fracture of the classification; diagnosis; Hoffa fracture; injury mechanism; treatment. Hoffa fragment associated with a femoral shaft fracture. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. 4). Shetty GM, Wang JH, Kim SK, et al. [5]. 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. Jarit GJ, Kummer FJ, Gibber MJ, et al. [15]. (A) The fresh 1.5cm1.5cm fracture surface of the lateral condyle of femur was found under arthroscopy. Shah JN, Howard JS, Flanigan DC, et al. 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. Careers. Am J Sports Med 2008;36:37994. The white arrow indicate the defect area. [25] A cannulated screw combined with a plate is recommended in these cases. Comminuted fractures are a type of broken bone. [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. 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 [10]. Mashoof AA, Scholl MD, Lahav A, et al. Min L, Tu CQ, Wang GL, et al. The authors have no conflicts of interest to disclose. [84]. [60]. [9]. 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. 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. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. Based on plate position, screws can be combined with a lateral antigliding plate[84] or a posterior antigliding plate.[55,87]. The goals of treatment include restoration of function and esthetics. Plate fixation for Letenneur type I. 2017;84:4417. [74]. 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. After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. The https:// ensures that you are connecting to the Wu P, WB, Kong LC, et al. [30]. Injury 2011;42:14958. McDonough PW, Bernstein RM. However, some patients had suture removal during the second arthroscopy because of suture irritation. Bicondylar. Ann Chir 1978;32:2139. sharing sensitive information, make sure youre on a federal 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. The Authors. [19] Therefore, lateral condyle fracture is significantly more common than medial condyle fracture. 1). [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]. Arthroscopic. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa's fracture with patellar dislocation - a rare case. Wagih AM. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . Goel A, Sabat D, Agrawal P. Arthroscopic-assisted fixation of, [13]. If fractures are present they are usually associated with orbital rim or other significant craniofacial injuries. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. [65]. Lee et al[13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. Many author think these injuries are caused by the impact between the patella and femoral condyle with a knee flexed over 90. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. your express consent. [39]. Cruciate fracture of the distal femur: the double. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. 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 Please try after some time. You may be trying to access this site from a secured browser on the server. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. Osteochondral Fracture Lateral Femoral Condyle Treated with - Hindawi FOIA We report a case of patellar dislocation with OCF in the weight-bearing area of LFC. Technique for Treatment of Subchondral Compression Fracture of the Lateral Femoral Condyle Associated With ACL Tear Technique for Treatment of Subchondral Compression Fracture of the Lateral Femoral Condyle Associated With ACL Tear Arthrosc Tech. Femoral condyle insufficiency fractures: associated clinical and Acta Chir Orthop Traumatol Cech. Injury 1989;20:3714. [104]. 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. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Skeletal Radiol 2015;44:3743. Fracture of the Femoral Condyles - Physio.co.uk Please enable it to take advantage of the complete set of features! Impaction Fracture of the Medial Femoral Condyle Zeebregts CJ, Zimmerman KW, ten Duis HJ. An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. Iwai T, Hamada M, Miyama T, et al. Calmet J, Mellado JM, Garcia Forcada IL, et al. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal. The patient had an uneventful postoperative recovery. [61]. Impact fractures are due to track formation and propagation. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. Bone contusion and associated meniscal and medial collateral - PubMed 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. 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. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. Arthroscopy. [96]. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. 2013;185:61120. Cartilage. [6]. 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. [9] The pain due to these combined injuries often exceeds that caused by the Hoffa fracture, which can lead physicians to miss the latter. [1]. The specific mechanism of a Hoffa fracture is not well understood. J Pediatr Orthop. McCarthy JJ, Parker RD. Int Orthop. Distal pulses and sensation were intact. Clinical outcomes after absorbable suture fixation of patellar, [26]. PDF ssslideshare.com [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. 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. [50]. Authors Federal government websites often end in .gov or .mil. [27]. 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. Ozturk A, Ozkan Y, Ozdemir RM. Surgically treated Hoffa Fractures with poor long-term functional results. Kapoor C, Merh A, Shah M, et al. J Trauma 2000;48:15960. 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). -. However, Gavaskar et al[2] argued that no evidence confirms this correlation. 2021. 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). Viskontas DG, Nork SE, Barei DP, et al. [77]. [89]. 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. In these fractures, the popliteus tendon and the lateral head of the gastrocnemius muscle remain attached to the fragment. [24]. The bone mass is missing at the fracture. 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. Gang et al[20] found that there was no statistically significant difference between surgical treatment and non-surgical treatment in patients with patellar side injury of medial collateral ligament of patella. 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. 2). 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. [42]. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. Osteochondral fractures of the lateral, [11]. [25] Loss of bone matrix results in brittle, weaker bones that break rather than bend with external force. Injury, 2005, 36: 862865. 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 . In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. Nandy K, Raman R, Vijay RK, et al. The patient was referred to an or- thopaedic surgeon, who recommended conservative management. Nonunion of coronal shear fracture of femoral condyle. FIGURE 1. A modified posterolateral approach for. Xray examination of right knee joint: free bone mass can be seen at the anterior edge of the femur in the knee joint. Jiang YR, Wang ZY, Zhang DB, et al. official website and that any information you provide is encrypted Transverse Hoffas or deep. Long term results of unicondylar fractures of the femur. 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. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. 8600 Rockville Pike 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%. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with For more information, please refer to our Privacy Policy. Impaction fracture of the medial femoral condyle - PubMed Coronal fractures of the lateral femoral condyle. Oper Dent 2007;32:25160. This system allows the classification of comminuted femoral condyle fractures. Subchondral insufficiency fracture of the knee - Radiopaedia Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. 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. [17]. White EA, Matcuk GR, Schein A, et al. 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. [51]. 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. We replaced the anchor suture with (ETHICON VICRYL PLUS VCP 359H) suture during the operation, which is an attempt based on the research of Li,[25] in order to avoid the second operation. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. Li WH, Li Y, Wang MY. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. An unusual fracture of the lateral femoral condyle in a child. Management of any globe injury generally takes precedence over fractures 1. Potini VC, Gehrmann RM. [20]. Femoral Condyle Fractures - Symptoms, Causes, Treatment | Physio [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. Unicondylar femoral fractures: therapeutic strategy and long-term results. -, Patel JM, Saleh KS, Burdick JA, Mauck RL. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Search for Similar Articles At present, open reduction is often used to treat osteochondral fractures. (PDF) Technique for Treatment of Subchondral Compression Fracture of 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 2018;31:38291. patellar margin thus corresponding to impaction injuries. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. [59]. 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. Wang JY, Liu Y, Li Y, et al. Intra-articular corrective osteotomy for malunited. Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with Wolters Kluwer Health [21] In contrast to unicondylar Hoffa fracture, a bicondylar Hoffa fracture is caused by a posterior and upward directed force and is not associated with knee valgus. 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. (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. Agarwal S, Giannoudis PV, Smith RM. J Orthop Surg Res 2012;7:21. A case of distal femur medial condyle Hoffa type II(C) fracture treated with headless screws. Some error has occurred while processing your request. [4]. Cheng S, Zaidi SF, Linnau KF. 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. [78]. 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.

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impaction fracture lateral femoral condyle treatment

impaction fracture lateral femoral condyle treatment