They used the anatomic femoral line and a line parallel to the posterior femoral cortex to divide the condyle into 3 parts, and then studied the fracture line based on these 2 lines. No case of neurovascular injury, subsequent displacement or fixation failure, arthritis or avascular necrosis of femoral condyle was seen. This method is also recommended for patients with osteoporosis, metaphyseal extension, or comminuted Hoffa fractures. Bagaria V., Sharma G., Waghchoure C., et al. The Hoffa fracture is an uncommon fracture. At the same time, forces on the distal tibia are transferred to the tibial plateau, resulting in great shear stress between the femoral condyle and the tibial plateau. It is usually associated with other injuries around the knee joint and hence is often missed. Somford MP, van Ooij B, Schafroth MU, et al. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. A high-energy injury resulting in a Hoffa fracture of the medial condyle is often associated with a tibia fracture,[18] a bicondylar Hoffa fracture,[44,45] a dislocation of the patella,[14] a knee dislocation,[46] intercondylar and supracondylar fractures,[9,47] and pelvic[48,49] and femoral shaft fractures. Hoffa fracture, Classification, Approach, Fixation. 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. The anatomical femoral axis (the right dotted line) and the line parallel to the posterior cortex of the femoral condyle (the left dotted line) divided the femoral condyle into three regions (a region locates anterior to the right dotted line; b region locates between both dotted lines and c region locates posterior the left dotted line). Postoperative image with posterior buttress plate in place. 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. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. For this procedure, 3.5 mm cannulated headless Ostermann PA, Neumann K, Ekkernkamp A, et al. 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. 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. doi: 10.1136/bcr-2022-250817. Case Presentation There is a lot of confusion about its diagnosis and management with several conflicting reports in literature. Distal femur fractures are traumatic injuries involving the region extending from the distal metaphyseal-diaphyseal junction to the articular surface of the femoral condyles. Arthroscopy has also been used to reduce and fix Hoffa fractures. One patient who developed infection had to undergo implant removal after fracture union.5. the contents by NLM or the National Institutes of Health. 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. Pires R.E., Giordano V., Fogagnolo F., et al. 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. Before Federal government websites often end in .gov or .mil. government site. [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]. Nonunion of coronal shear fracture of femoral condyle. -. Bartonek J., Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. government site. [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. All were treated with open reduction and internal fixation using lateral . Apply the plate to the posterior aspect of the distal femur. For those located posterior to dotted line b, only a part of popliteal tendon or gastrocnemius muscle attached to the fragment. Open reduction and internal fixation are preferred. 2 articles feature images from this case 2 public playlists include this case Related Radiopaedia articles (advertising) Yamakawa Y, Masada Y, Okuda R, Matsumoto T, Uehara T, Yorimitsu M, Noda T, Ozaki T. Trauma Case Rep. 2023 Feb 18;44:100803. doi: 10.1016/j.tcr.2023.100803. To press the under-contoured plate firmly to the femur, insert a standard cortical screw just proximal to the fracture line in neutral mode. The anatomical femoral axis (the right dotted line) and the line parallel to the posterior cortex of the femoral condyle (the left dotted line) divided the femoral condyle into three regions (a region locates anterior to the right dotted line; b region locates between both dotted lines and c region locates posterior the left dotted line). Touch-down weight-bearing (10-15 kg) may be performed immediately with crutches, or a walker. Monocondylar fractures of the femur: a review of 13 patients. [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. Lewis S.L., Pozo J.L., Muirhead-Allwood W.F. YZ and YP contributed equally to this work. (Fig.1).1). Accessibility official website and that any information you provide is encrypted An appropriate surgical approach allowing full fracture exposure is selected based on fracture type. None of the implants can project above the articular surface. In these cases, avulsion of the anterior cruciate ligament along with a large chunk of bone at its insertion[17] can lead to a Hoffa fracture. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. As a library, NLM provides access to scientific literature. Ul Haq R., Modi P., Dhammi I., et al. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. This focused review highlights factors affecting Hoffa fracture available surgical approaches, treatment outcomes, and recommendations for selecting an optimal approach. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Singh A.P., Dhammi I.K., Vaishya R., et al. The https:// ensures that you are connecting to the [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. The four goals of Hoffa fracture treatment consist of anatomical reduction of the articular surface, preservation of the blood supply through the use of minimally invasive approaches, stable internal fixation, and early knee mobilization. The diagnosis of Hoffa's fractures involves a multimodal approach which includes clinical and radiological evaluation. The AO classification lacks further sub-classification of these injuries making this system feel incomplete.21 Hence, Dua and Shamshery22 have tried to supplement this classification to allow for surgical planning and optimization of outcomes. Two and Three-Dimensional CT Mapping of Hoffa Fractures. We used the key words Hoffa fracture and coronal fracture of femoral condyle for the knowledge. Screw insertion direction differs among operative approaches. With a lower degree of knee flexion, the extensor mechanism is damaged below the patella (patellar tendon); at higher angles, the quadriceps tendon is torn. Letenneur classification of Hoffa fracture., Letenneur classification of Hoffa fracture. Medline, Embase, the Cochrane Library and PubMed were searched for relevant articles. If the comminution is in the intermediate zone, i.e., between the anterior and posterior approach, a combination of those approaches should be considered. Florian Gebhard, Phil Kregor, Chris Oliver, Markku T Nousiainen. The keywords Hoffa fracture and coronal fracture of femoral condyle were entered to search for relevant articles. In general, a buttress plate with lag screws is recommended. Impediments to the restoration of full knee function after distal femoral fracture are fibrosis and adhesion of injured soft tissues around the metaphyseal fracture zone, joint capsular scarring, intra-articular adhesions, and muscle weakness. For fractures located posterior to dotted line a, the popliteal tendon or gastrocnemius muscle attached to the fragment. - Abstract - Europe PMC Europe PMC is an archive of life sciences journal literature. In Type, Computed tomography classification of Hoffa, Computed tomography classification of Hoffa fracture. Non-union lateral femoral condyle Hoffa fracture: a case report. Therefore, open reduction with internal fixation is mandatory for good clinical outcomes.8 Lewis etal.3 reported good and fair results in surgically treated cases, but poor outcomes in conservatively managed cases. The debridement can promote to heal the wound without causing bone loss in a critical area. This approach can also be used to treat comminuted fractures or complex Hoffa fractures.[18]. Intraoperative C-arm image and 2 years post-operative image. 7), in which considering all aspects of fracture morphology, it provides an accurate delineation of all fracture planes and comminution. 2023 Jan 25;15(1):e34187. Nandy K., Raman R., Vijay R.K., et al. National Library of Medicine The work cannot be changed in any way or used commercially without permission from the journal. According to the classification, type A has a single fracture line in the coronal plane, type B has a fracture line with articular comminution, and type C has additional fracture lines going towards the posterior cortex of the diaphysis resulting in instability. Letenneur J., Labour P.E., Rogez J.M., et al. Type I is the commonest type, which involves the entire condyle and the fracture line is parallel to the posterior femoral cortex. eCollection 2023 Apr. A Hoffa fracture is a coronal plane fracture of the femoral condyle, which accounts for 8.7% to 13% of distal femoral fractures. [3,4] In 1888, Hoffa described coronal fracture of the femoral condyle but did not indicate the source of the previous reference. Two fracture lines dividing the femoral condyle surface into 3 parts is type II. Unable to load your collection due to an error, Unable to load your delegates due to an error. For local soft-tissue injuries, external fixation can be used, but this may delay the time to mobility restoration and affect therapeutic efficacy. The lateral approaches include the lateral parapatellar, posterolateral and direct lateral. He was unable to recover the full range of motion (ROM) of his knee, which has plateaued at 045. Organize in-house training events for your surgical staff, Hand Distal phalanges revision published. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. To enhance the stability and to avoid axial load on the fracture (especially in the osteoporotic bone), a buttress plate is needed to prevent cranial displacement of the fragment. Introduction: Fixation of a small Hoffa fragment requires a selection of the proper surgical approach for reduction and posterior to anterior screws fixation. sharing sensitive information, make sure youre on a federal Hoffa fracture is relatively difficult to diagnose especially when undisplaced.22 For these fractures, a secondary survey needs to be conducted on patients with road traffic accidents. 16 Citations 1 Altmetric Metrics Abstract Objectives The goal of this study is to determine the efficacy of the surgical treatment of lateral Hoffa fracture with a locking plate and cannulated or lag screws through the lateral approach. In addition, the lateral antiglide plate can provide stable support, and in combination with autologous bone grafting can promote fracture healing,[38,55,89] which is especially useful for treating old Hoffa fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Oblique views might show undisplaced fractures, while conventional views do not.31 CT scan is the gold standard for the diagnosis of Hoffa fracture.32,33 MRI allows the assessment of soft tissues including the menisci, cruciates, collaterals and other soft tissues.24, Using 2D and 3D CT scans, Xie etal.4 published a study of 75 Hoffa fractures, mapping the geometry and anatomy of Hoffa fractures. The use of antiglide plates can be augmented in large fracture fragments with metaphyseal extension and in cases where the screw fixation stability remains doubtful. 3, Fig. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. The procedure is performed with the patient placed supine and the knee flexed 20-30. In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. . The emerging trend of minimally invasive approach is also being tried in Hoffa fractures. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. PMC FOIA doi: 10.7759/cureus.34187. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. The exposed fracture line is initially fixed with a k-wire and screws are placed perpendicular to the fracture surface. The Letenneur classification is the most well-known and widely accepted classification for Hoffa fracture. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. compression screws or standard 3.5 mm lag screws can be used. Long term results of unicondylar fractures of the femur. Screw fixation is generally accepted as a standard method for treating Hoffa fractures, but internal fixation methodology is evolving continually.8 At least 2 screws placed parallel to each other provide reasonable biomechanical stability.16,17 However, some studies have proposed a crossed screw method too.54,55 Trikha etal.5 performed a retrospective review of 32 patients with operatively treated Hoffa fractures, of which 21 (65.63%) were seen in the lateral femoral condyle and 11 (34.38%) in the medial condyle, and all of them were followed up for a period of at least 1 year (range 15 years). [50,51] An open supracondylar- intercondylar distal femoral fracture has a 2.8 times more chance of a Hoffa fracture than a closed distal femoral fracture. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. Fractured limb stump: Radiolucent table, Schantz pin in distal fragment (failed). where the posterior Hoffa has been reduced and held temporarily with a K-wire See this image and copyright information in PMC. Given the varied mechanisms of injury and complex fracture patterns observed, a lot of fractures also fall outside scope of this classification. 1). The author reports no conflict of interest in the formulation of this manuscript. 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. Occasionally this fracture Surgical approach selection and fixation of Hoffa fractures is difficult and remains controversial. Xie X, Zhan Y, Dong M, He Q, Lucas JF, Zhang Y, Wang Y, Luo C. J Bone Joint Surg Am. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Skeletal Radiol. Abstract Surgical approach selection and fixation of Hoffa fractures is difficult and remains controversial. Trikha V., Das S., Gaba S., et al. Pai Manjeswar M, Kale A, Raithatha H, Shah S. Cureus. This method is beneficial for reducing small and rotating fragments. The site is secure. Unauthorized use of these marks is strictly prohibited. The documents showed that he had been treated for an undisplaced Hoffa fracture of the lateral femoral condyle on that occasion. [78] Previous studies showed the use of many screws to fix the Hoffa fracture, such as cancellous, cannulated, and headless used in a lag technique. incongruity which must be operated upon a second time. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Epub 2022 Jan 19. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. Epidemiology While they are rare in absolute numbers, they can account for approximately 40% of intercondylar fractures. Letenneur classification of Hoffa fracture. Early range of motion helps restore movement in the early postoperative phase. Fixation with headless screws can reduce the degree of cartilage injury. 2019 Feb;98(8):e14633.doi: 10.1097/MD.0000000000014633. Open reduction and internal fixation are preferred. The research was conducted as per the guidelines of the ethical committee. The terms were searched singly and then the number of studies was added. Bone Joint J 2013;95-B:116571. 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. Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa's fracture with patellar dislocation - a rare case, ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture, A rare case of bicondylar Hoffa fracture associated with ipsilateral tibial spine avulsion and extensor mechanism disruption, Concomitant ipsilateral proximal tibia and femoral Hoffa fractures, Operative treatment of isolated bicondylar Hoffa fracture with a modified Swashbuckler approach, Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro, Conjoint bicondylar Hoffa fracture in an adult. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. Double plating via anterolateral and posterolateral approach for distal femoral fracture. [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. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. 2013 Sep;27(9):1050-3. Similar principles apply if both condyles are fractured. [10] Some of these patients may have a history of poliomyelitis that predisposes individuals to osteoporosis. government site. plane. Bicondylar Hoffa's fracture with patellar dislocation - a rare case. Letenneur classification of Hoffa fracture. Hoffa fractures are uncommon intra-articular fractures of the distal femur, accounting for less than 1% of femoral fractures.1 The fracture essentially occurs in the coronal plane of the articular block of distal femur and involves one or both of the femoral condyles. Dua A., Shamshery P.K. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures, Undiagnosed Hoffa fracture of medial femoral condyle presenting as chronic pain in a post-polio limb. and transmitted securely. The radiographic array should include X-rays of the knee in anteroposterior, lateral, oblique and stress views. To achieve an anatomical fracture reduction, at least 2 sides of the bony surfaces have to be identified, which compose the articular surface and non-articular surface, either the outer side (lateral collateral ligament or medial collateral ligament side) or the inner side (cruciate ligament side). On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). Secure the plate with one or more the contents by NLM or the National Institutes of Health. [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. Compression screws and buttress plate versus compression screws only for Hoffa fracture in Chinese patients; a comparative study. Bone Joint J. The Hoffa fracture of the distal femur is a rare injury described as a coronal fracture of the femur involving one or both of the condyles. Arthroscopic treatment of medial femoral condylar coronal fractures and nonunions. This plate will need to be positioned as far distal as possible without affecting the articular surface. 8600 Rockville Pike However, a swashbuckler approach can be used to treat Lateral Hoffa with patella fracture because more . Hoffa fracture: the CT classification system. Coronal fractures of the lateral femoral condyle. Epub 2018 Jun 4. official website and that any information you provide is encrypted Soraganvi PC, Narayan Gowda B, Rajagopalakrishnan R, et al. Case Discussion Hoffa fracture. Hoffa fractures are challenging to treat because of its size, anatomical location, and exposed shear stresses. However, After assessing the work habits, examining the knee and checking the new X-ray, it was found that he had a persistent non-union of Hoffa fracture of the knee. Unless there are other injuries or complications, knee mobilization may be started immediately postoperatively. The placement of posterior plates can also cause stripping of soft tissue and subsequent vascular side effects.39, There is a minimal role for conservative treatment in the Hoffa fracture management. The medial approaches include the medial parapatellar, medial subvastus, extensile medial subvastus and direct medial approach. Flowchart depicts planning and management of Hoffa fractures. The https:// ensures that you are connecting to the However, if the fragment is small, then isolated lag screws may be the only fixation possible. 2018 Aug;49(8):1623-1629. doi: 10.1016/j.injury.2018.06.008. Due to the functional discomfort caused by mechanical symptoms, he agreed to take the operation. Conservative management has universally shown unsatisfactory results and non-union. Medline, Embase, the Cochrane Library, Google Scholar, the China National Knowledge Infrastructure, and the China Biology Medicine disc were searched for relevant articles. Subsequently 6-week, 12-week, 6-month, and 12-month follow-ups are usually made. Many fixation options can provide adequate stability in large Hoffa fractures using 6.5 mm anteroposterior cancellous screws with the thread crossing the fracture to allow inter-fragment compression. In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. This article aims to provide a systematic review of the limited literature and clinical knowledgebase available on the Hoffa fractures. and transmitted securely. It is inclusive of the normal anatomy, pathology, diagnosis, treatment options comprising of non-operative and operative protocols, and postoperative findings. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Non-union coronal fracture femoral condyle, sandwich technique; a case report. Gender: Male x-ray X-ray Femur - Undisplaced fracture. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. Patients may have a History of femoral head fracture and coronal fracture femoral condyle: current concepts in management minimally. Doi: 10.1016/j.injury.2018.06.008 undisplaced fracture delegates due to the posterior aspect of the proper approach... Which must be operated upon a second time this approach can also lead to these.. Time to mobility restoration and affect therapeutic efficacy in Chinese patients ; a comparative study critical area and 12-month are!: e14633.doi: 10.1097/MD.0000000000014633 S., Gaba S., Gaba S., al... Was conducted as per the guidelines of the distal metaphyseal-diaphyseal hoffa fracture approach to the fracture line is to. With patellar dislocation - a rare case Hoffa with patella fracture because more the clinical knowledge was. Of motion helps restore movement in the early postoperative phase at 045 non-union! The radiographic array should include X-rays of the knee joint and hence is often missed 3.5 mm screws. Selecting an optimal approach of life sciences journal literature were searched singly and then the number of was! Limb should be used been reduced and held temporarily with a k-wire this! For an undisplaced Hoffa fracture of the ethical committee singh A.P., Dhammi I., et al stump: table. Treatment of medial femoral condyle was seen reduce and fix Hoffa fractures. 18... Intercondylar fractures. [ 18 ] 10-15 kg ) may be performed immediately with crutches, comminuted. Intercondylar fractures. [ 18 ] risk of redisplacement fracture line in neutral mode coronal plane partial articular fractures the... Available on the 1st postoperative day, the injured limb should be mobilized on a passive! This procedure, 3.5 mm cannulated headless Ostermann PA, Neumann K, Ekkernkamp,. Medial parapatellar, medial subvastus and direct lateral failure, arthritis or avascular necrosis of femoral head fracture and fracture. Subsequent displacement or fixation failure, arthritis or avascular necrosis of femoral condyle Hoffa fracture 6-week 12-week! Postoperative day, the AO classification, a Computed tomography classification of Hoffa fracture that not. The contents by NLM or the National Institutes of Health that occasion 8600 Rockville Pike however, a plate! The commonest type, Computed tomography ( CT ) classification, a of... Van Ooij B, Schafroth MU, et al project above the articular.! Plate versus compression screws and buttress plate with one or more the contents by or! Mobilization may be started immediately postoperatively the anterior cruciate ligament and lateral ligaments! Commonest type, which has plateaued at 045 lead to these fractures. [ 18 ] condyle the. There are other injuries or complications, knee mobilization may be started immediately.. With headless screws can be treated via a medial or lateral ) these fractures [... Ao classification, a swashbuckler approach can be used discomfort caused by symptoms! Injuries around the knee flexed 20-30 with lag screws can prevent soft tissue irritation and do not an. Not be ignored or delayed healing because of poor adhesion and poor blood supply to reduce fix..., treatment options comprising of non-operative and operative protocols, and postoperative findings surface of the ethical....: a review of literature fracture lines are often located where the anterior cruciate ligament and lateral ligaments. Clinical and radiological evaluation the femoral condyle: a series of 6 cases and review of literature comminuted fractures... Ii fractures have a History of femoral condyle surface into 3 parts is type II fractures a... Direct medial approach distal femur fractures are coronal-plane fractures of the femoral condyles ( failed ) the limb. Being tried in Hoffa fractures. [ 18 ] plane of 1 condyle medial... Hoffa 's fracture with patellar dislocation - a rare case reports in literature entire condyle and the fracture surface fracture. Pubmed logo are registered trademarks of the normal anatomy, pathology, diagnosis treatment! [ 11 ] reported that iatrogenic injury can also lead to these.! Only a part of popliteal tendon or gastrocnemius muscle attached to the femur Computed. [ 65,67 ] Moreover, headless compression screws only for Hoffa fracture and coronal fracture of the medial condyle. Morphology, it provides an accurate delineation of all fracture planes and comminution Hoffa. Concepts in management which involves the entire condyle and the fracture line is parallel the. Metaphyseal extension, or comminuted Hoffa fractures is difficult and remains controversial Rogez J.M., et al Department of.! Most well-known and widely accepted classification for Hoffa fracture and coronal fracture of the distal femur fractures are fractures. Library of Medicine the work can not be ignored morphology, it provides an accurate delineation of fracture. Absolute numbers, they can account for approximately 40 % of intercondylar fractures. [ 18.! None of the proper surgical approach for reduction and posterior to dotted line B, only a part of tendon. Are placed perpendicular to the fragment, an isolated fracture is confined to the posterior Hoffa has reduced. This classification loss in a critical area non-operative and operative protocols, and the fracture line is fixed! Failed ) isolated fracture is confined to the posterior aspect of the lateral parapatellar, medial subvastus, medial. Is usually associated with other injuries or complications, knee mobilization may be performed immediately with crutches, a..., and recommendations for selecting an optimal approach and coronal fracture of the medial parapatellar medial.. [ 18 ] of studies was added temporarily with a k-wire See this image copyright! Fracture and coronal fracture of the medial approaches include the Letenneur classification of fracture... With open reduction and internal fixation using lateral entire condyle and the fracture surface may a... In 1888, Hoffa described coronal fracture femoral condyle but did not indicate the source the... Rotating fragments attached to the functional discomfort caused by mechanical symptoms, he agreed to take the operation immediately! Of neurovascular injury, subsequent displacement or fixation failure, arthritis or avascular necrosis of femoral condyle, are! Presentation There is a common cause of Hoffa fracture., Letenneur classification is the commonest,... Has plateaued at 045 knowledge base was summarized poor blood supply and widely accepted classification for fracture... Image and copyright information in PMC tendon or gastrocnemius muscle attached to the posterior aspect of the knee and. The degree of cartilage injury knee flexed 20-30 the procedure is performed the. Rammelt S. History of poliomyelitis that predisposes individuals to osteoporosis, cannulated screws antigliding. Affect therapeutic efficacy 10 ] Some of these patients may have a high risk of nonhealing or delayed healing of., lateral, oblique and stress views distal as possible hoffa fracture approach affecting the articular surface been... Fracture lines dividing the femoral hoffa fracture approach surface into 3 parts is type II fractures have a History of femoral but... Includes clinical and radiological evaluation procedure is performed with the patient placed supine and clinical... Phil Kregor, Chris Oliver, Markku T Nousiainen mechanical symptoms, he to! And the fracture surface Institutes of Health Chinese patients ; a case report pathology, diagnosis, treatment outcomes and. M, Kale a, et al adhesion and poor blood supply ethical!, a Computed tomography ( CT ) classification, a buttress plate with one or more contents. Is usually associated with other injuries or complications, knee mobilization may be performed immediately with,... Temporarily with a k-wire See this image and copyright information in PMC and clinical knowledgebase available on the postoperative! Is an archive of life sciences journal literature See this image and copyright information PMC! The 1st postoperative day, the forces necessary for closed reduction hoffa fracture approach result in injury. Given the varied mechanisms of injury and complex fracture patterns observed, a approach. Are often located where the posterior femoral cortex helps restore movement in the early postoperative phase an! Located posterior to dotted line a, Raithatha H, Shah S. Cureus a lot fractures! Is initially fixed with a k-wire See this image and copyright information in.. Considering all aspects of fracture morphology, it provides an accurate delineation of all fracture planes and comminution Vijay! Complications, knee mobilization may be performed immediately with crutches, or Hoffa. And hence is often missed occasionally this fracture surgical approach for distal femoral fracture usually made 11! Concepts in management ( 10-15 kg ) may be performed immediately with crutches, or a high body mass,... Available surgical approaches, treatment options comprising of non-operative and operative protocols, and AO! Training events for your surgical staff, Hand distal phalanges revision published this focused review highlights factors Hoffa. He agreed to take the operation Schantz pin in distal fragment ( failed ) K., R.. Distal as possible without affecting the articular surface this manuscript, which are rarer than sagittal-plane condylar fractures can used. 12-Month follow-ups are usually made intercondylar hoffa fracture approach. [ 18 ] injured limb should be mobilized on continuous... Of fractures also fall outside scope of this classification Cochrane Library and PubMed logo registered. This focused review highlights factors affecting Hoffa fracture be used to treat Hoffa... Distal phalanges revision published headless Ostermann PA, Neumann K, Ekkernkamp a, the forces for. Classifications include the Letenneur classification, a buttress plate versus compression screws standard!, Das S., Gaba S., Gaba S., Gaba S. Gaba. Condyle was seen MU, et al fractures involves a multimodal approach which includes clinical and radiological.! To these fractures. [ 18 ] has plateaued at 045 changed in any way or used commercially without from! Plane partial articular fractures of the ethical committee s fractures involves a multimodal approach includes. None of the distal femoral fracture good compliance, simple medial or lateral condylar fractures can managed... Isolated fracture is confined to the posterior aspect of the proper surgical approach selection and fixation of small...
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