[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. Please try again soon. 1). Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. [93]. 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. [95] Because Hoffa fractures are intra-articular, the success of anatomical reduction and firm internal fixation is closely related to postoperative complications like traumatic arthritis. 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). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. Ercin E, Baca E, Kural C. Arthroscopic. [8]. Pure lateral blow-out fractures are rare, as the bone is thick and bounded by muscle. Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures. [21]. Lateral radiographs of the affected knee were inspected for a . Recently, impaction fractures in the non-weight-bearing area of the lateral femoral condyle were reported in 16 of 6600 patients who underwent knee MRI. eCollection 2021 Jan. Uimonen MM, Repo JP, Huttunen TT, Nurmi H, Mattila VM, Paloneva J. Knee Surg Sports Traumatol Arthrosc. For local soft-tissue injuries, external fixation can be used, but this may delay the time to mobility restoration and affect therapeutic efficacy. [40]. Operative. Agarwal S, Giannoudis PV, Smith RM. [89]. 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. In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. [91]. The use of several 3.5-mm-diameter screws is recommended to fix the fractures. J Knee Surg 2013;26(Suppl 1):S8993. After hospitalization, the patients underwent computed tomography scan and magnetic resonance examination. This site needs JavaScript to work properly. After 1 year follow-up, good functional and radiographic outcome were obtained. 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. Long term results of unicondylar fractures of the femur. Acta Orthop Traumatol Turc 2014;48:3837. 5cm cartilage mass was stripped from nonweight-bearing area of the LFC, and no osteochondral mass was found at the medial edge of patella (Fig. [2]. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. Skeletal Radiol 2015;44:3743. 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. HHS Vulnerability Disclosure, Help 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. We used the key words Hoffa fracture and coronal fracture of femoral condyle for the knowledge. Am J Sports Med 2008;36:37994. Ozturk A, Ozkan Y, Ozdemir RM. Search for Similar Articles MRI of osteochondral defects of the lateral, [3]. Bali K, Mootha AK, Krishnan V, 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. Tan et al[75] recommended an improved posterolateral approach starting from the space between the peroneal nerve and the biceps femoris. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. Treatment and prognosis. Before Intertrochanteric femoral fractures account for 3.13% of total adult fractures, 24.56% of femoral fractures, and 50% of proximal femoral fractures (Koval et al. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Atesok K, Doral MN, Whipple T, et al. [19] Therefore, lateral condyle fracture is significantly more common than medial condyle fracture. Zhou S, Cai M, Huang K. Treatment of. Pathology. Partial ceramic crowns: influence of ceramic thickness, preparation design and luting material on fracture resistance and marginal integrity in vitro. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. 2003;19:71721. 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. [16]. Radiography can reveal fracture lines. 2021. Tripathy SK, Aggarwal A, Patel S, et al. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. [56]. Epub 2018 Oct 4. The incidence ratio in male and female patients is in the range . 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. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. At present, open reduction is often used to treat osteochondral fractures. Am J Sports Med. The Authors. [14,15] Diederichs et al[16] suggest that a first patellar dislocation is often treated conservatively, and loose body removal, microfracture and internal fixation should be selected according to the size and location of osteochondral block. [52] This fact reminds us that a Hoffa fracture evaluation should be a routine part of the lower-limb and pelvis examination with or without injury. The distal femur is where the bone flares out like an upside-down funnel. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. [104] To prevent habitual patellar dislocation, repair of the medial retinaculum complex or a combination of lateral retinacular release[14,105] and simultaneous patellar ligament insertion on the tibial tubercle is recommended. Lateral-view radiograph of the left knee demonstrating an abnormally deep depression of the medial condylopatellar sulcus (arrow). Repair of displaced partial articular fracture of the distal femur: the. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Arthroscopic; Internal fixation; Osteochondral fracture; Suture anchor; TWINFIX Ti. [10]. Kapoor C, Merh A, Shah M, et al. Lee SY, Niikura T, Iwakura T, et al. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. A rare case of unicondylar medial, [24]. Radiographic appearance 2). Acta Biomater, 2019, 93:222238. Summary Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Med Sci Monit, 2012, 18: CS117CS120. Moreover, the placement of a posterior antiglide plate with screws strips more soft tissue, especially the insertion of the gastrocnemius heads, and may destroy the blood supply to the fragments. 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. A patient, 15-year-old, female student. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. 2018;31:38291. Tsai et al[103] reported that surgical treatment is the 1st choice for Hoffa fracture accompanied by traumatic patella dislocation; if conservative treatment is adopted, the redislocation rate is as high as 40%. Xu Y, Li H, Yang HH, et al. Difficulties involved in the Hoffa fractures [in German]. [94]. The https:// ensures that you are connecting to the [83]. The term comminuted fracture refers to a bone that is broken in at least two places. Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. Comminuted fractures are caused by severe traumas like car accidents. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. Zeebregts CJ, Zimmerman KW, ten Duis HJ. Gesslein M, Merkl C, Bail HJ, et al. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. sharing sensitive information, make sure youre on a federal Lal H, Bansal P, Khare R, et al. Clipboard, Search History, and several other advanced features are temporarily unavailable. [48]. Unable to load your collection due to an error, Unable to load your delegates due to an error. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. This is the first report on a fracture of medial femoral condyle treated with this implant. [Resorbable pin refixation of an osteochondral fracture of the lateral femoral condyle due to traumatic patellar dislocation: case management, follow-up and strategy in adolescents]. [36]. In types III and IV (unicondylar coronal plane fracture with supracondylar or intercondylar distal femoral fractures, respectively), fixation is needed as for isolated Hoffa fracture in addition to stabilization with a metaphyseal bridging implant or a fixed-angle device. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Mashoof AA, Scholl MD, Lahav A, et al. your express consent. Friederichs et al[24] reported cases of opposing articular surface cartilage injury caused by bioabsorbable screws, which required second operation. The patient was referred to an or- thopaedic surgeon, who recommended conservative management. [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 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. [101]. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. Arthroscopic. Int Orthop. -. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by-nc-nd/4.0, Hoffa fracture of the femoral condyle: Injury mechanism, classification, diagnosis, and treatment, Articles in Google Scholar by Yabin Zhou, MD, Other articles in this journal by Yabin Zhou, MD, Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A meta-analysis of randomized controlled trails, Hoffa fracture combined with rotational dislocation of the knee joint: A novel case report, PET/CT-negative malignant spine tumor with pathologic fracture: A case report of malignant solitary bone plasmacytoma, Prognostic factors to survival of patients with chondroblastic osteosarcoma, Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis, Privacy Policy (Updated December 15, 2022). The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. [5] Viskontas et al[69] reported an extensile medial subvastus approach that allows better exposure of the surgical field and protects the blood supply of the bones comparing with the medial parapatellar approach. Arthroscopy-assisted, [55]. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. 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.. [90]. 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. Knee Surg Sports Traumatol Arthrosc. [38]. J Clin Orthop Trauma 2015;6:4650. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. Life (Basel). Knee flexion was limited less than 60 within 8 weeks after operation, partial weight-bearing was allowed at 8 weeks, followed by full weight bearing from 12 weeks after operation. (C) The free edge of the anterior foot of the meniscus was rough (degree I). This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. Werner BC, Miller MD. 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). Sanders TG, Paruchuri NB, Zlatkin MB. Acta Orthop Belg 2001;67:1328. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. J Surg Case Rep 2012;2012:10. The distal femur is the area of the leg just above the knee joint. This sign represents a severe bone contusion caused by impression, and microfracturing, visible on MRI, and is suspect for an impacted (osteo)chondral fracture due to a tear of . [9]. Soni A, Sen RK, Saini UC, et al. This is the first case to apply the suture anchor system to the reduction and fixation of fracture. Your message has been successfully sent to your colleague. The risk of blood vessel damage when using this approach is minimal but the common peroneal nerve should be isolated first. [19]. The most common way to fracture the femoral condyles is jumping from a large height. Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature. Two cartilage masses can be seen during the operation. Allmann KH, Altehoefer C, Wildanger G, et al. Lateral Femoral Condyle (LFC) osteochondral fracture (HSL, Hill-Sachs-like Lesion) can be seen in 30 of knee flexion. Meyer C, Enns P, Alt V, et al. (B) BULLET fixed at the entrance of the lateral bone canal of the distal femur. Khle J, Angele P, Balcarek P, et al. Arthrosc Tech 2015;4:e299303. McDonough PW, Bernstein RM. J Knee Surg. Cartilage. Factors of patellar instability: an anatomic radiographic study. [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. Manfredini M, Gildone A, Ferrante R, et al. [61]. Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. 2017;84:4417. Acute patellar dislocation in children and adolescents: a randomized clinical trial. Biau DJ, Schranz PJ. Accessibility [14]. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). 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. Unfallchirurg 2004;107:1521. Matthewson MH, Dandy DJ. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. Wolters Kluwer Health [18]. ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. 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). Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. 4). Osteochondral fractures of the lateral. [10] Some of these patients may have a history of poliomyelitis that predisposes individuals to osteoporosis. Three types of fracture are defined based on the coronal fracture line (Fig. 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. [31]. Keyword Highlighting 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. Please try after some time. FOIA 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. Please try after some time. [28]. Acta Orthop Traumatol Turc. [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. findings identifies vascular segments with diminished flow vascular injury Transverse Hoffa's or deep osteochondral fracture? [20]. The patient had no previous history of patella dislocation and pain around the knee. For Letenneur II and some Letenneur III fractures close to the posterior cortex of the femoral condyle, cannulated lag screw fixation is commonly used. (A) Use of anterior cruciate ligament locator to assist drilling at the distal end of the femur. Biau DJ, Schranz PJ. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. 2013;185:61120. Soraganvi PC, Narayan Gowda B, Rajagopalakrishnan R, et al. J Trauma 2000;48:15960. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. 2018 Oct;21(5):308-310. doi: 10.1016/j.cjtee.2018.08.004. The funding sources have no role in study design, literature collection, review, data analysis, and manuscript preparation. Musculoskelet Surg 2012;96:4954. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. Oral application of Qiangguyin Keli and alendronate sodium vitamin D3 tablets in postoperative anti-osteoporosis. The patient's treatment plan included 6 weeks of weight bearing as tolerated for the left lower extremity while wearing a knee brace that prevented the final 20 of knee extension, and a program of range-of-motion and progressive resistive exercises, with eventual emphasis on sport-specific activities. 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 View Large Image Download Hi-res image Download (PPT) [41]. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. 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. Impaction Fracture of the Medial Femoral Condyle assessment of the anterior cruciate liga- ment with the anterior drawer and Lach- man tests was negative for laxity. Therefore, further studies are needed to improve the quality of Hoffa fracture reduction under arthroscopy. Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. [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. [43]. [ 21] Matthewson et al [ 21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early [60]. normal vital signs. Materials and methods: This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Bioactive factors for cartilage repair and regeneration: improving delivery, retention, and activity. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. doi: 10.1016/j.eats.2020.02.016. Zhao LL, Tong PJ, Xiao LW. For more information, please refer to our Privacy Policy. Li ZX, Song HH, Wang Q, et al. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. Introduction. Radiographs of knee joint show loose body in joint. Vaishya R, Singh AP, Dar IT, et al. Osteochondral injuries of the knee in pediatric patients. [5]. 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. For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. [97]. Friederichs MG, Greis PE, Burks RT. Bicondylar. 2021;13(1_suppl):966S73S. Calmet J, Mellado JM, Garcia Forcada IL, et al. Authors Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. 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. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. A case report. Other structures may be fractured at the same time due to the great forces experienced through the femur bones. PMC Dhillon MS, Mootha AK, Bali K, et al. Knee 2004;11:1257. Rue JP, Busam ML, Detterline AJ, et al. Akan K, Akgun U, Poyanli O, et al. Operative, [46]. Onay T, Glabi D, olak , et al. Braune C, Rehart S, Kerschbaumer F, Jger A. Cartilage injury of lateral femoral condyle (LFC) caused by patellar dislocation is very common, with an incidence rate of 31% to 40%. For simple lateral condylar Hoffa fractures, a patellar anterolateral approach is most commonly used. You may search for similar articles that contain these same keywords or you may 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. Internal fixation with lag screws plus an antigliding plate for the, [88]. A lateral incision plus Gerdy tubercle osteotomy provides full exposure[68] especially in cases of coronal fracture of the lateral condyle. [58]. 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. According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. Chauhan A. Irreducible, incarcerated vertical dislocation of the patella into a. This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). The specific mechanism of a Hoffa fracture is not well understood. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. Careers. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. Federlin M, Krifka S, Herpich M, et al. Apropos of 128 cases]. may email you for journal alerts and information, but is committed [51]. [20]. (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. Am J Sports Med. Two bone tunnels are made from anteromedial to posterolateral with 2mm Kirschner wire at the front edge of osteochondral mass. Postoperative reexamination of computed tomography scan showed that the bone block was well reduced. 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. [21,22], In some patients, a Hoffa fracture is associated with a patellar fracture. Marzouki A, Zizah S, Benabid M, et al. However, the latest biomechanical study[88] showed that lateral antiglide plate has greater anti-shearing strength than posterior fixation. Rev Chir Orthop Reparatrice Appar Mot. Injury 2015;46:41921. J Orthop Trauma 1994;8:1426. [23]. Li R, Guo G, Chen B, Zhu L, Lin A. Arthroscopicallyassisted reduction and fixation of an old osteochondral fracture of the lateral femoral condyle. Arthroscopy. Ji G, Wang S, Wang X, et al. (B) The sutures passing through the bone canal and the corresponding sutures on the anchor were tightened and fixed. Medicine (Baltimore). A comparison of the clinical effect of two fixation methods on Hoffa fractures. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). Would you like email updates of new search results? The goals of treatment include restoration of function and esthetics. You may search for similar articles that contain these same keywords or you may Sun H, He QF, Huang YG, et al. Nonunion of a. A biomechanical study[5] shown that several smaller-diameter screws cause less damage to the joint cartilage than larger-diameter screws but that both have the same tensile force. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. Lee et al[13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. Callewier A, Monsaert A, Lamraski G. Lateral. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. [53,91] However, some Hoffa fractures combined with a tear of the posterolateral horn of the lateral meniscus are identified intraoperatively, and tear of the lateral meniscus can be repaired with suture anchors. We prospectively documented all potential cases of non-weight-bearing posterior subchondral impaction fractures of the femoral condyles diagnosed on magnetic resonance imaging (MRI) of the knee performed at our institution between January 2006 and December 2011. 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%.

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