Sahu RL, Gupta P. Operative management of, [44]. Published by Wolters Kluwer Health, Inc. Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. 1986;14:11720. [51]. [94]. 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. The authors have no funding and conflicts of interest to disclose. Osteochondral injuries of the knee in pediatric patients. Highlight selected keywords in the article text. your express consent. [9] The pain due to these combined injuries often exceeds that caused by the Hoffa fracture, which can lead physicians to miss the latter. 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. Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. Many author think these injuries are caused by the impact between the patella and femoral condyle with a knee flexed over 90. Pathology The likely mechanism is a hyperextension or impaction injury with a collision of the femoral condyle and the posterior tibial plateau during the rotational movement responsible for injuring the ACL, most commonly the pivot-shift. Jabalameli M, Bagherifard A, Hadi H, et al. The Authors. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. [25] Loss of bone matrix results in brittle, weaker bones that break rather than bend with external force. This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. Cruciate fracture of the distal femur: the double. YZ and YP contributed equally to this work. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). Osteochondral fracture involving the weight-bearing portion of the lateral femoral condyle is relatively rare injury as it involves hyper flexion of the knee at the time of . Acta Biomater, 2019, 93:222238. 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. J Orthop Surg Res 2012;7:21. Your message has been successfully sent to your colleague. (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. Acta Chir Orthop Traumatol Cech. Liebergall M, Wilber JH, Mosheiff R, et al. 1). Suture anchor system is mostly used to repair rotator cuff and patellar tendon. Apropos of 128 cases]. This study was supported by the National Natural Science Foundation of China (grant no: 81401789) and the Top Young Talents for Hebei Province (20162018). We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteen-year-old male with a positive history of significant weight gain of 5 kilograms in last six months. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). -, Patel JM, Saleh KS, Burdick JA, Mauck RL. Materials and methods: This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Search for Similar Articles [2]. FIGURE 2. Arthroscopy-assisted fracture fixation. Vivek T, Saubhik Da, Sahil G, et al. 1982;68:31725. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. Please try again soon. Vaishya R, Singh AP, Dar IT, et al. [91]. Arthrosc Tech 2015;4:e299303. Incarcerated patellar tendon in. 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. Atesok K, Doral MN, Whipple T, et al. Hoffa fragment associated with a femoral shaft fracture. 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). [18]. Ann Chir 1978;32:2139. Hoffa nonunion, two cases treated with headless compression screws. Dejour H, Walch G, Nove-Josserand L, et al. Int Orthop 2015;39:124550. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. 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. 2022 Dec 16;101(50):e32104. Musculoskelet Surg 2012;96:4954. Postoperative reexamination of computed tomography scan showed that the bone block was well reduced. [36]. Arthroscopy-assisted, [55]. [53]. Intertrochanteric femoral fractures occur mostly in the elderly, and the average age of onset is 66-76 years. 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. lateral femoral condyle fractures in 80% Angiography indications ankle-brachial index (ABI) <0.9 obvious signs of vascular injury i.e., hard and soft signs (pulselessness, rapidly expanding hematoma, massive bleeding, etc.) [73] This approach is suitable for the treatment of Hoffa fracture with patella dislocation. may email you for journal alerts and information, but is committed For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). Radiography can reveal fracture lines. J Orthop Surg 2017;25:17. Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout: a cadaveric study. Mootha AK, Majety P, Kumar V. Undiagnosed, [11]. MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . Two cartilage masses can be seen during the operation. [25]. Min L, Tu CQ, Wang GL, et al. [17]. 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. After physical examination, it was found that apprehension test was negative, patellar glide and tilt tests was negative. [30]. Wolters Kluwer Health [38]. MRI of osteochondral defects of the lateral, [3]. Fracture and dislocation compendium: Orthopaedic Trauma Association Committee for Coding and, [35]. A case of distal femur medial condyle Hoffa type II(C) fracture treated with headless screws. Oral application of Qiangguyin Keli and alendronate sodium vitamin D3 tablets in postoperative anti-osteoporosis. Osteochondral defects of LFC are usually caused by lateral patellar dislocation, most of which are located on the medial side of patella. 1). http://creativecommons.org/licenses/by-nc-nd/4.0. Gerdy's tubercle osteotomy for the, [69]. following anterior cruciate ligament repair) Location The recognized sites of osteochondral defects are: femoral condyle (most common in the lateral aspect of the medial femoral condyle) humeral head talus capitellum of the humerus Staging Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. 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 . (C) CT examination of the left knee joint: the continuity of the subarticular bone of the lateral condyle of the left femur was interrupted. Matthewson MH, Dandy DJ. Arthroscopy. [2] This fracture type was 1st described by Busch in 1869. [99]. Maenpaa H, Huhtala H, Lehto MU. [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. * Correspondence: Lijiang He, Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Hangzhou, Zhejiang 311121, China (e-mail: [emailprotected]). 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. Arthroscopy. Life (Basel). During complete anterior cruciate ligament (ACL) tears in pivoting mechanisms, the area of the lateral femoral condyle (LFC) localized just above the anterior third of the lateral meniscus (LM) impacts the posterior border of the lateral tibial plateau (LTP), which may result in a subchondral compression fracture. 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. 2018 Oct;21(5):308-310. doi: 10.1016/j.cjtee.2018.08.004. [19]. 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. Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. [5-9] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. (LTC, Lateral Tibial Condyle.) Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). Gelber PE, Erquicia J, Abat F, et al. 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. Surgically treated Hoffa Fractures with poor long-term functional results. [7]. [60]. The term comminuted fracture refers to a bone that is broken in at least two places. Fracture surgery complications include: Acute compartment syndrome (ACS): A build-up of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage. [92]. Ostermann PA, Neumann K, Ekkernkamp A, et al. 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. [20]. For more information, please refer to our Privacy Policy. [58]. [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. Highlight selected keywords in the article text. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [4]. [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]. Rue JP, Busam ML, Detterline AJ, et al. to maintaining your privacy and will not share your personal information without Arthroscopic. Moreover, even if the medial patellar retinaculum is strengthened, the patient still has symptoms such as anterior knee pain. Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. [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 contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. Z Orthop Ihre Grenzgeb. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. Ul Haq R, Modi P, Dhammi I, et al. Gesslein M, Merkl C, Bail HJ, et al. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. [53] In addition, partial nondisplaced Hoffa fractures are difficult to diagnose on anteroposterior and lateral views of the knee because the fracture lines often overlaps the side or lateral condyle, which can result in a missed diagnosis in as many as 30% of cases.[9,18]. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. [25] A cannulated screw combined with a plate is recommended in these cases. Radiographic features Usually, subchondral fractures present as linear or curvilinear structures often paralleling the subchondral bone plate, with or without areas of subchondral collapse 2. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. Shetty GM, Wang JH, Kim SK, et al. Comminuted fractures are caused by severe traumas like car accidents. [10,38] Local manifestations of a Hoffa fracture include knee swelling, pain, skin color changes (with or without skin defects), limited knee mobility, and a positive floating patella test. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. [6]. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. How to cite this article: Wu L, Liu C, Jiang B, He L. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. Intraoperative, [12]. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. Operative. Bauer KL. your express consent. eCollection 2021 Jan. Uimonen MM, Repo JP, Huttunen TT, Nurmi H, Mattila VM, Paloneva J. Knee Surg Sports Traumatol Arthrosc. (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. Anchor absorbable suture bridge fixation is rigid enough, which can avoid second operation, save cost and good outcome could be expected, which is worth exploring; Of course, a large number of clinical data are needed for further comparative study. 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. Injury 2005;36:8625. Wu P, WB, Kong LC, et al. Screw insertion direction differs among operative approaches. Paa L, Vesel R, Koi J, et al. (B) 1.5cm1.5cm free bone was found in the knee joint cavity, and the bone fracture was intact. Sasidharan B, Shetty S, Philip S, et al. McCarthy JJ, Parker RD. 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. [64]. [101]. Bicondylar. Difficulties involved in the Hoffa fractures [in German]. 2020 Jun 15;9 (6):e823-e828. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. Epub 2020 Sep 18. [Patella infera. Federal government websites often end in .gov or .mil. [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. Refixation of large osteochondral fractures after patella dislocation shows better mid- to long-term outcome compared with debridement. [6,45,48,5863] Therefore, we must strictly control the indications for conservative treatment. 2020 The Authors. However, Gavaskar et al[2] argued that no evidence confirms this correlation. [98]. When the patient has patellar dislocation with OCF in the weight-bearing area of LFC, surgical treatment and internal fixation is the treatment of choice if the OCF can be fixed. [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. In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. 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. Gang et al[20] found that there was no statistically significant difference between surgical treatment and non-surgical treatment in patients with patellar side injury of medial collateral ligament of patella. [96]. 1 It has been proved that compression of the posterior border of . [89]. [81] For patients who require a longer healing time, such as those with a higher body mass index or poor compliance, the simple application of a cannulated screw is insufficient to counter the great shearing force between condyles and the tibial plateau when the knee is in flexion. [ 21] Matthewson et al [ 21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa's fracture with patellar dislocation - a rare case. Tripathy SK, Aggarwal A, Patel S, et al. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. 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. Knee 2004;11:1257. A review of 23 patients. Open reduction and internal fixation are preferred. classification; diagnosis; Hoffa fracture; injury mechanism; treatment. [80]. 2021 Jan 26;9(1):2325967120974649. doi: 10.1177/2325967120974649. The patient had no previous history of patella dislocation and pain around the knee. J Pediatr Orthop B, 2013, 22: 344349. Unfallchirurg 2004;107:1521. Med Sci Monit, 2012, 18: CS117CS120. J Pediatr Orthop. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral, [14]. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Arastu MH, Kokke MC, Duffy PJ, et al. J Orthop Trauma 2002;16:17881. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. [43] If radiographic examination is not diagnostic but a Hoffa fracture is suspected, a CT scan, which is the gold standard for diagnosis of a Hoffa fracture, should be performed. Further improvements in arthroscopic-assisted reduction and other minimally invasive surgery technologies will help improve patient prognosis. [7]. Please try after some time. According to the internal fixation principle, the antiglide plate should be fixed in the posterior position. Complained of swelling and pain of the right knee after spraining during sports activities, demonstrated painful limited motion. Chin J Traumatol 2011;14:1436. [74]. Search for Similar Articles Hoffa's fractures. Please enable it to take advantage of the complete set of features! Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. Reconstructive osteotomy for a malunited medial. Seeley MA, Knesek M, Vanderhave KL. Frangakis EK. Tan et al[75] recommended an improved posterolateral approach starting from the space between the peroneal nerve and the biceps femoris. official website and that any information you provide is encrypted 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. Li R, Guo G, Chen B, Zhu L, Lin A. Arthroscopicallyassisted reduction and fixation of an old osteochondral fracture of the lateral femoral condyle. Lee et al[13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. Antigliding plating for Letenneur type I Hoffa fractures. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. Treatment and prognosis. Lateral-view radiograph of the left knee demonstrating an abnormally deep depression of the medial condylopatellar sulcus (arrow). Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. J Orthop Trauma 2006;20:2736. [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]. J Orthop Trauma 1994;8:1426. Potini VC, Gehrmann RM. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. [10] Werner and Miller [11] reported that iatrogenic injury is a cause of Hoffa fracture . Coronal plane fracture of the femoral condyles: anatomy, injury patterns, and approach to management of the Hoffa fragment. modify the keyword list to augment your search. Jain A, Agrawal P, Chadha M, et al. The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. In this paper, three cases of osteochondral fracture of lateral femoral condyle were treated with arthroscopic TWINFIX Ti suture anchor internal fixation, and good results were obtained. -. Epub 2018 Oct 4. J Clin Orthop Trauma 2014;5:3841. 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. 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. [4]. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. [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. 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%. [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. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. After hospitalization, the patients underwent computed tomography scan and magnetic resonance examination. Long term results of unicondylar fractures of the femur. Orthopedics, 2016, 39: e362e366. 2023 Jan;15(1):103-110. doi: 10.1111/os.13586. Authors 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). Shah JN, Howard JS, Flanigan DC, et al. The treatment options for OCF of LFC include: loose body removal, microfracture, open reduction and internal fixation, cartilage transplantation, autologous or allogeneic osteochondral transplantation, etc. Soni A, Sen RK, Saini UC, et al. patellar margin thus corresponding to impaction injuries. Lateral radiographs of the affected knee were inspected for a . ;Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Cartilage. J Knee Surg 2008;21:23540. Tong W, Yang J, Xu PL, et al. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. Matthewson et al[10] believe OCF in weight-bearing area of LFC with patellar dislocation is caused by the shearing forces between the LFC and the lateral tibial plateau as they pivot under load. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. White EA, Matcuk GR, Schein A, et al. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. The incidence ratio in male and female patients is in the range . Acute patellar dislocation in children and adolescents: a randomized clinical trial. Management of any globe injury generally takes precedence over fractures 1. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. J Knee Surg. The anatomical plate for distal medial condyle fracture of femur should be developed as soon as possible. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. [18]. Medicine (Baltimore). Chin J Traumatol. Jarit GJ, Kummer FJ, Gibber MJ, et al. Impact fractures can be classified either as ductile or brittle depending on the elongation pattern that is present. Preliminary X-ray examination showed osteochondral defects of LFC and loose body in knee joint (Fig. [76,77] Fixation with 2 or more screws can prevent rotation and rotational displacement. (A) One 1.5mm Kirschner wire temporarily fixed the fracture block of the lateral condyle of the femur. 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. Suture anchors are drilled into the posterolateral tibia to repair the meniscus to the meniscosynovial junction. For Letenneur II and some Letenneur III fractures close to the posterior cortex of the femoral condyle, cannulated lag screw fixation is commonly used. According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. Akan K, Akgun U, Poyanli O, et al. [97]. (C) Making a small incision on the outside of the knee joint, it is convenient to drill two 2.0mm bone channels from the distal end of the femur from the outside to the intercondylar fossa. Lax patellar attachments are thought to place adolescent boys at higher risk of patellar dislocation.
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