The patient had no previous history of patella dislocation and pain around the knee. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. Intertrochanteric femoral fractures occur mostly in the elderly, and the average age of onset is 66-76 years. Incarcerated patellar tendon in. [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. Seeley MA, Knesek M, Vanderhave KL. Wang JY, Liu Y, Li Y, et al. Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. J Clin Orthop Trauma 2015;6:4650. Before 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. [24]. Vaishya R, Singh AP, Dar IT, et al. Transverse Hoffas or deep. Efficacy of multiple Acutrak hollow head compression screws in the, [68]. PMC (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. [66]. 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. Lateral radiographs of the affected knee were inspected for a . Arthroscopy. Hoffa's fractures. 8600 Rockville Pike 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. Lateral Femoral Condyle (LFC) osteochondral fracture (HSL, Hill-Sachs-like Lesion) can be seen in 30 of knee flexion. J Bone Joint Surg Br 1989;71:11820. J Bone Joint Surg Am 2005;87:5649. After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. 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. Ann Chir 1978;32:2139. Marzouki A, Zizah S, Benabid M, et al. Difficulties involved in the Hoffa fractures [in German]. A case report. computed tomography scan and magnetic resonance (MRI) examination of knee joint further confirmed loose body within the knee joint, osteochondral defect in weight-bearing area of LFC and avulsion of medial patellofemoral ligament (Fig. Search for Similar Articles Werner BC, Miller MD. [10] Some of these patients may have a history of poliomyelitis that predisposes individuals to osteoporosis. 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 This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Monocondylar fractures of the femur: a review of 13 patients. Previous article . After 1 year follow-up, good functional and radiographic outcome were obtained. Choudhary RK, Tice JW. Intra-articular dislocation of the patella. Oral application of Qiangguyin Keli and alendronate sodium vitamin D3 tablets in postoperative anti-osteoporosis. [96]. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. Westmoreland GL, McLaurin TM, Hutton WC. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. With rapid developments in transportation, construction, and industry, the incidence of Hoffa fractures has gradually increased. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. You may be trying to access this site from a secured browser on the server. Non-union coronal fracture femoral condyle, sandwich technique: a case report. Twenty-seven-year nonunion of a. Medline, Embase, the Cochrane Library, Google Scholar, the China National Knowledge Infrastructure, and the China Biology Medicine disc were searched for relevant articles. [50]. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). Knee Surg Sports Traumatol Arthrosc 2011;19:3209. 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. [7]. Open reduction and internal fixation are preferred. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Arthroscopy 2011;27:81724. [15,16] These forces cause gross displacement of the condyle, which can not only rupture the quadriceps tendon but also perforate the skin, resulting in an open injury. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. Arthrosc Tech 2015;4:e299303. This article reviews the mechanism, diagnosis, classification, and treatment of Hoffa fractures. (C) CT examination of the left knee joint: the continuity of the subarticular bone of the lateral condyle of the left femur was interrupted. 1). J Orthop Trauma 1994;8:1426. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. 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 Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. 4). Pathology. modify the keyword list to augment your search. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. Type 2 fractures require a . [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. Gao M, Tao J, Zhou Z, et al. Gesslein M, Merkl C, Bail HJ, et al. For more information, please refer to our Privacy Policy. 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. Epub 2007 Mar 23. This system allows the classification of comminuted femoral condyle fractures. [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. 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. [10]. [83]. [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. [100]. The anatomical plate for distal medial condyle fracture of femur should be developed as soon as possible. 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. [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]. Smith EJ, Crichlow TP, Roberts PH. [98]. Internal fixation with lag screws plus an antigliding plate for the, [88]. Complications of anterior cruciate ligament reconstruction with bone-patellar tendon-bone constructs: care and prevention. Vivek T, Saubhik Da, Sahil G, et al. Data is temporarily unavailable. -, Patel JM, Saleh KS, Burdick JA, Mauck RL. McDonough PW, Bernstein RM. In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. Two patients with osteochondral injury of the weight-bearing portion of the lateral. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. Zeebregts CJ, Zimmerman KW, ten Duis HJ. Jarit GJ, Kummer FJ, Gibber MJ, et al. 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 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. Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. Tripathy SK, Aggarwal A, Patel S, et al. Paa L, Vesel R, Koi J, et al. Zhou S, Cai M, Huang K. Treatment of. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. Based on plate position, screws can be combined with a lateral antigliding plate[84] or a posterior antigliding plate.[55,87]. -, Morris John K, Weber Alexander E, Morris Mark S. Adolescent femoral chondral fragment fixation with polyLlactic acid chondral darts. government site. 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 . Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. Acta Orthop Scand 1997;68:4246. Li WH, Li Y, Wang MY. Intraoperative, [12]. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. 5 and 6), and the lysholm score was 95 points, which was very good. Materials and methods: This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. The tears of the lateral meniscus and medial meniscus were detected during arthroscopy. Valgus strain on the knee and the continuous pull of the quadriceps causes the patella to ride against the femoral condyle, resulting in rotation around its vertical axis. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. [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. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. 2013;33:5118. [80]. However, some patients had suture removal during the second arthroscopy because of suture irritation. 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. 3). Neglected. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. Ul Haq R, Modi P, Dhammi I, et al. Unicondylar femoral fractures: therapeutic strategy and long-term results. Recurrence after patellar dislocation. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. Osteochondral injury after acute patellar dislocation in children and adolescents. Visual observation revealed significant right knee effusion and an inability to bear weight on the right lower extremity or flex his knee beyond 80. Chin J Traumatol 2011;14:1436. Ozturk A, Ozkan Y, Ozdemir RM. The distal femur is where the bone flares out like an upside-down funnel. 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]. [75]. Cheng S, Zaidi SF, Linnau KF. 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. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Preliminary X-ray examination showed osteochondral defects of LFC and loose body in knee joint (Fig. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. [21]. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. Rofo. 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). Gerdy's tubercle osteotomy for the, [69]. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. 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.. (B) BULLET fixed at the entrance of the lateral bone canal of the distal femur. You may be trying to access this site from a secured browser on the server. 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. Viskontas DG, Nork SE, Barei DP, et al. 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. The Authors. Anatomic reduction of the articular surface, stable fixation, and early mobilization should be the aims of treatment. [47]. Three types of fracture are defined based on the coronal fracture line (Fig. 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 . 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. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. Manfredini M, Gildone A, Ferrante R, et al. View Large Image Download Hi-res image Download (PPT) Springerplus 2016;5:1164. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. Internal fixation with headless compression screws and back buttress plate for. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. [36]. Autologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic 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. 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.
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