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Resumen: Introducción: Las fracturas del cóndilo femoral en el plano coronal o fracturas de Hoffa se encuentran entre las fracturas más raras del miembro pélvico, pero son aún más raras las del cóndilo medial. El éxito en el manejo de estos pacientes radica en el diagnóstico oportuno y la consecuente reducción anatómica de la superficie articular del fémur. Caso clínico: El objetivo de este reporte es presentar a un paciente con el diagnóstico de fractura de Hoffa medial derecha, registrado como caso único en los archivos de nuestro hospital. El paciente acudió referido en Noviembre de 2011, con evolución de 10 días tras sufrir caída de caballo, presentando mecanismo de varo forzado y contusión directa de la rodilla derecha. Mostró radiografías anteroposterior y lateral de rodilla derecha, donde se observó de forma sutil solución de la continuidad en el plano coronal de la base del cóndilo medial, corroborado por resonancia magnética y asociado a lesiones parciales no quirúrgicas de ambos meniscos y del ligamento cruzado anterior. Se intervino quirúrgicamente el día 27 de Noviembre de 2011 mediante reducción abierta con abordaje medial y fijación interna con dos tornillos canulados de 7.0 mm. Se egresó al paciente indicando la movilización temprana y continua de la rodilla, difiriendo el apoyo y rehabilitación hasta la sexta semana. Actualmente el paciente se encuentra con posibilidad de deambulación, asintomático y con arcos de movilidad completos. El respeto del aparato extensor mediante un abordaje medial y la superficie articular con tornillos canulados se refleja en la adecuada evolución de nuestro paciente, pudiendo regresar a sus actividades diarias, incluso el montar.
Abstract: Introduction: Knee femoral condyle coronal fractures or Hoffa fractures are among the rarest fractures of the pelvic limb, being even more rare those of the medial condyle. The success in the management of these patients lies in the timely diagnosis and the consequent anatomical reduction of the femoral articular surface. Clinical case: The objective of this article is to present a patient with right medial Hoffa fracture, registered as a single case in the archives of our hospital. The patient was referred to us on November 2011, with a 10-day course after suffering a fall from horse ridding, presenting a forced varus mechanism and direct contusion of the right knee. He shows an anteroposterior and lateral knee X-rays showing a subtle solution of continuity in the coronal plane of the base of the medial condyle, corroborated with magnetic resonance imaging and was also associated with a non-surgical partial injury of both menisci and the anterior cruciate ligament. Surgical intervention was performed on 27th/11/2011, through open reduction with a medial approach and internal fixation with 7.0 mm (x2) cannulated screws. The patient was discharged with early and continuous mobilization of the knee, deferring support and rehabilitation until the 6th week. He is currently a wandering patient, asymptomatic, with complete range of motion. Because respecting the extensor apparatus through a medial approach and the articular surface with cannulated screws, it was observed in consequence an adequate evolution of our patient, being able to return to his daily activities, even remount.
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Introduction:Upper end of tibia is an important component of knee joint. The aim of present study is to analyse different morphometric parameters of condylar and intercondylar surface of tibia, so as to formulate a baseline data for future studies with relevance to Indian population and to compare the current data with previous literature. Morphometric study of upper end of tibia can be used to guide treatment and monitor outcome of total knee replacement surgeries. Material and Method: 30 dried human adult tibia were obtained from Dept. of anatomy SKIMS Medical College bemina Srinagar. Morphometric measurements of medial condyle, lateral condyle and intercondylar area of tibiae were measured with Vernier caliper.Result: Anteroposterior measurements were found to be greater than transverse measurements for both medial and lateral condyles. Furthermore, both anteroposterior and transverse measurements were greater in medial condyle than in lateral condyle.Racial differences were observed.Conclusion:The present study is to provide a base line data pertaining to morphometric details of upper end of tibia in Indian population, which aims to provide help for anatomists, anthropologists, and orthopedics, in knee arthroplasty procedures, and meniscal transplantation
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Hoffa fractures are intra-articular fractures of the distal femoral condyles in coronal plane. These fractures may be of either condylebut lateral condyle is most commonly affected and medial condyle is extremely rare. Non-operative treatment of unicondylarfemur fractures, including Hoffa fractures, yields poor result. We present a case of 9-year-old child with Hoffa fracture of medialfemoral condyle with understanding of the mechanism of injury and its further management. He had history of fall from height ofabout 5 feet on his right knee which was in flexed position at around 90°. X-ray of knee showed fracture of medial femoral condylein coronal plane. Three-dimensional (3D) reconstruction of computed tomography (CT) scan confirmed the coronal fracture ofmedial femoral condyle and was classified as Type 33 B3 according to orthopedic trauma association classification and Type 1as per Letenneur classification. Open reduction and internal fixation were performed with partially threaded cancellous screws.The fixation of coronal fracture of medial femoral condyle done through cancellous screws in anterior to posterior direction wasadequate in giving stable fixation and aided in union without disturbing the physis of the child. At 1 year, the child could do fullextension and 130° flexion. There was no posterior or varus, valgus instability of the knee. We believe that a medial condyleHoffa fracture is extremely rare in children, and the diagnosis can be missed. ORIF using partially threaded cancellous screwsin the epiphysis provides stable fixation and can lead to a good functional outcome in the long term. The mechanism of injuryin this fracture pattern was found to be direct impact on the knee in flexed position of 90°.
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Background: Arthritis and injuries of the knee are frequently managed by knee arthroplasty. Knee prosthesis thus used needs population specific appropriate sizing. The aim of the study is to analyse tibial plateau morphometrically.Methods: The study included 46 human tibia bones (28 left and 18 right). The anteroposterior length and transverse width of superior articular surface of both tibial condyles along with the anteroposterior length and transverse measurements of the intercondylar area were noted with digital Vernier caliper. The data was tabulated and analysed.Results: For the superior articular surface of medial condyle, anteroposterior length was found to be 4.12±0.42cm on left side and 4.17±0.50cm on right side; maximum width was found to be 2.81±0.59cm on left side and 2.78±0.34cm on right side. For the superior surface of lateral condyle, the anteroposterior length was found to be 3.92±0.30cm on left side and 3.66±0.31cm on right side whereas maximum width was found to be 3.12±0.68cm on left side and 2.87±0.55cm on right side. Anteroposterior length of intercondylar area was measured to be 4.31±0.40cm on left side and 4.18±0.44cm on right side. The transverse measurement was recorded to be 3.12±0.68cm (left side), 2.87±0.55cm (right side) anteriorly; 1.25±0.23cm (left side), 1.31±0.20cm (right side) in the middle and 1.28±0.39cm (left side), 1.85±0.42cm (right side) posteriorly.Conclusions: The results will be helpful in orthopaedic surgical procedures involving knee.
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Background: The purpose of this study was to evaluate role of Posteromedial Plating in condylar fractures of Tibia, especially patients with posterior tibial shear fractures. Materials and methods: This prospective study included 12 patients with mean age 40 years (range 30 to 50 years) who sustained high velocity posterior tibial plateau fracture-subluxations with/ without associated Bicondylar fractures (Moore I & II Types, Schatzker’s Groups – IV, V and VI). Surgical management included stabilisation plating through a posteromedial/ posterior approach and additional postero lateral or antero lateral approach as needed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Oxford Knee Score and Lyshom Score. Results: The mean OKS score was 40 (range 36 to 44) at the end of one year. The main clinical measures were early post-operative non weight bearing ROM, post-operative complication and functional outcome. The time to full weight bearing, the rate of post-operative complications and functional outcome was significantly better as evident by over 94 % showing good to excellent OKS and Lyshom scores. Conclusion: A posterior/ postero medial approach for posterior tibial plateau shear fractures (which are otherwise irreducible by conventional approaches) and buttress/ antiglide plate are usually needed to reduce the fractures anatomically, achieving absolute stability and mobilize early NWB, ROM of the knee joint to optimize the functional outcomes and minimize the complications, without the need for revision surgery.
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Intraoperative fracture in total knee arthroplasty (TKA) is a rare complication. However, when it happens, additional surgery to fix the fracture site is needed. Therefore, it is important to diagnose intraoperative fractures in TKA exactly. The authors experienced two cases of cortical perforation of medial femoral condyle misidentified as the fracture in TKA. Cortical perforation could be misdiagnosed as the fracture, which could lead to unnecessary surgery. This is the first report about cortical perforation in TKA. We report two cases of intraoperative cortical perforations and describe the radiological characteristics.
Subject(s)
Arthroplasty , Arthroplasty, Replacement, Knee , Femur , Knee , Unnecessary ProceduresABSTRACT
PURPOSE: To evaluate clinical and radiological results of surgical treatment of distal femur medial condyle fracture using lateral anatomical plate of opposite side through medial approach. MATERIALS AND METHODS: This study reviewed the results of 9 cases of distal femur medial condyle fracture treated with lateral anatomical plate of opposite side through medial approach from December 2005 to June 2007, after a follow up of more than 12 months. There were 2 males and 7 females with a mean age of 63.1 (57~72) years. The clinical results were evaluated using the Schatzker's criteria, and the radiographic results were evaluated using the bone union time. RESULTS: Using the Schatzker's criteria, 7 cases of the 9 patients (78%) showed exellent results. The mean time for bone union was 13.4 (11~15) weeks. There were 3 cases of pain on full weight bearing same as previous operative state by degenerative osteoarthritis. There weren't complications as joint stiffness, infection, varus & rotational deformity, malunion, nonunion, and metal failure. CONCLUSION: Plate fixation using medial approach provides the proper anatomical reduction and stronger fixation, and outcome good results.
Subject(s)
Female , Humans , Male , Congenital Abnormalities , Femur , Follow-Up Studies , Joints , Osteoarthritis , Weight-BearingABSTRACT
[Objective] We analyzed the clinical findings in 5 patients with osteonecrosis in the medial condyle of the tibia. We also evaluated the usefulness of a tibial percussion test that we developed for examination of differences between the healthy and affected sides in percussion caused by knocking on the tibial rough surface.<BR>[Methods] The subjects were 5 females, who consulted our hospital with a chief complaint of gonalgia and in whom conditions such as osteonecrosis in the medial condyle of the tibia were confirmed by MRI in 4 limbs. In addition to X-p, MRI findings, medical findings by interview, and findings by physical examination were evaluated as clinical findings. Furthermore, the tibial percussion test was performed.<BR>[Results] The causes of pain in the knee joint were unclear in all patients. Pain was severe in 3 patients and marked in 2 patients. Physical examination showed marked tenderness in the medial articular gap and tenderness in the medial condyle of the tibia. In all patients, a difference in the percussion findings between the healthy and affected sides was confirmed by the tibial percussion test.<BR>[Conclusions] These findings indicated that the tibia percussion test in addition to confirmation of characteristic clinical conditions, such as the initial condition of the disease and the severity of tenderness, is useful for the evaluation of conditions of this disease.