Arthroscopic-assisted fixation of. Medicine101(50):e32104, December 16, 2022. The patellar height was in the normal range (Caton-Deschamp index 1.0). 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. Nakagawa S, Arai Y, Inoue H, et al. Cartilage. 3021 Tibial plateau fractures - fixation (a) Two or three lag screws may be sufficient for simple split fractures (type l), though 'b) a buttress plate ard screws may be more secure. Rue JP, Busam ML, Detterline AJ, et al. Gerdy's tubercle osteotomy for the, [69]. The patient had an uneventful postoperative recovery. [41]. Bone Joint J 2013;95-B:116571. Life (Basel). Ann Chir 1978;32:2139. doi: 10.1016/j.arthro.2006.11.029. This article discusses anatomic considerations, classification of condylar fractures, indications for surgery, treatment options, and complications. On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. J Bone Joint Surg Am 2006;88:22704. Acta Chir Orthop Traumatol Cech. 2018;31:38291. Lee et al[13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. [30]. Ercin E, Bilgili MG, Basaran SH, et al. Keywords: Biau DJ, Schranz PJ. Agarwal S, Giannoudis PV, Smith RM. Diederichs G, Scheffler S. [MRI after patellar dislocation: assessment of risk factors and injury to the joint]. [17]. [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. Bauer KL. [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. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Lateral radiographs of the affected knee were inspected for a . 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.) Long term results of unicondylar fractures of the femur. [19] Therefore, lateral condyle fracture is significantly more common than medial condyle fracture. [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]. [20]. your express consent. Intraoperative, [12]. 1994;2:1926. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In some cases, the Letenneur II fragment is small but essential for the knee join when flexed at 90 because it ensures the articular surface integrity. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. Singh R, Singh RB, Mahendra M. Functional outcome of isolated Hoffa fractures treated with cannulated cancellous screw. In the type I, an isolated fracture is confined to the coronal plane of 1 condyle (medial or lateral). ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. Zeebregts CJ, Zimmerman KW, ten Duis HJ. Soft tissues are retracted to . Federlin M, Krifka S, Herpich M, et al. View Large Image Download Hi-res image Download (PPT) Wu, Liang MMa; Liu, Chao BMb; Jiang, Bing BMc; He, Lijiang MMd,*, a Department of Orthopedic Surgery, First Peoples Hospital of Linpin District, Hangzhou, Zhejiang, China, b Department of General Surgery, Medicine Faculty of Universitas Prima Indonesia, North Sumatra, Indonesia, c Department of General Surgery, Daocheng Country Peoples Hospital, Sichuan, China. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. cDepartment of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China. [28]. [77]. [3]. 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. In these cases, the associated patellar fracture results from a combination of forces: direct trauma causing the Hoffa fracture and possible indirect injuries from sudden contraction of the quadriceps muscle causing a vertical patellar fracture.[23]. Injury, 2005, 36: 862865. osteochondral impaction fracture postsurgical (e.g. Orthopedics, 2016, 39: e362e366. This method is also recommended for patients with osteoporosis, metaphyseal extension, or comminuted Hoffa fractures. [4]. For local soft-tissue injuries, external fixation can be used, but this may delay the time to mobility restoration and affect therapeutic efficacy. Chin J Orthop Trauma 2009;9:8503. At present, open reduction is often used to treat osteochondral fractures. [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]. 8600 Rockville Pike Surgically treated Hoffa Fractures with poor long-term functional results. [12,37] Orthopedic surgeons treating these patients should be vigilant in diagnosing a Hoffa fracture; patients with undiagnosed injuries experience long-term knee pain and limited knee mobility. Dave LY, Nyland J, Caborn DN. Skeletal Radiol 2015;44:3743. At present, open reduction is often used to treat osteochondral fractures. [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. A patella that is stuck between the tibia and femur can be relocated naturally by flexing of the hip joint with the knee in 110 of flexion under local anesthesia. FOIA A hip fracture is a break that occurs in the upper part of the femur (thigh bone). 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. 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. 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. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. Intra-articular corrective osteotomy for malunited. (LTC, Lateral Tibial Condyle.) Xray examination of right knee joint: free bone mass can be seen at the anterior edge of the femur in the knee joint. In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. Intra-articular dislocation of the patella. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . For simple lateral condylar Hoffa fractures, a patellar anterolateral approach is most commonly used. Starr AJ, Jones AL, Reinert CM. According to the severity of Hoffa fracture and combined injuries, a reasonable treatment plan can be developed. 2013;185:61120. Arastu MH, Kokke MC, Duffy PJ, et al. [1]. 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. Tan et al[75] recommended an improved posterolateral approach starting from the space between the peroneal nerve and the biceps femoris. Osteochondral fractures of the lateral, [11]. 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. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. 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. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Matthewson MH, Dandy DJ. Am J Sports Med. Sharath RK, Gadi D, Grover A, et al. Operative. [95]. Some error has occurred while processing your request. 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. Arthroscopy. Zhou S, Cai M, Huang K. Treatment of. Jain SK, Jadaan M, Rahall E. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Ostermann PA, Neumann K, Ekkernkamp A, et al. 2013;37:238594. Osteochondral fracture of the lateral femoral condyle is a rare injury of the knee joint, which mostly occurs in adolescence 1.In adolescence, the cartilage-bone interface is the weakest transitional area in the knee joint, and there is no obvious boundary between calcified and uncalcified cartilage 2.The biomechanical strength of immature osteochondral junction was lower than . [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. Callewier et al[23] reported a patient who used absorbable pin fixation to treat OCF in the weight-bearing area of LFC. [21]. Some error has occurred while processing your request. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. For more information, please refer to our Privacy Policy. Data is temporarily unavailable. Posterior wall blowout in anterior cruciate ligament reconstruction: avoidance, recognition, and salvage. A review of 23 patients. ;Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Incarcerated patellar tendon in. 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. This article reviews the mechanism, diagnosis, classification, and treatment of Hoffa fractures. doi: 10.1016/j.eats.2020.02.016. PMC The goals of treatment include restoration of function and esthetics. Management of any globe injury generally takes precedence over fractures 1. Buttress plating for a rare case of comminuted medial condylar. Unicondylar femoral fractures: therapeutic strategy and long-term results. Vivek T, Saubhik Da, Sahil G, et al. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. The risk of blood vessel damage when using this approach is minimal but the common peroneal nerve should be isolated first. 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. Arthroscopic management of a posterior femoral condyle (Hoffa) fracture: surgical technique. Lateral-view radiograph of the left knee demonstrating an abnormally deep depression of the medial condylopatellar sulcus (arrow). Li ZX, Song HH, Wang Q, et al. On lateral radiographs, the normal femoral condyles overlap, and bone cortex interruption may not be visible. J Orthop Surg 2017;25:17. Tripathy SK, Aggarwal A, Patel S, et al. Highlight selected keywords in the article text. Search for Similar Articles [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. The widely known Letenneur classification not only clarifies the relationships between the fracture line and ligaments and soft tissue, but also has significance for clinical treatment and prognosis. 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. Disclaimer. Please try again soon. An unusual fracture of the lateral femoral condyle in a child. Analysis of functional outcome of Hoffa fractures: a retrospective review of 32 patients. Materials and methods: This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Epub 2007 Mar 23. The functional and radiographic outcome were satisfactory at 18 months after operation. Please try again soon. Hoffa nonunion, two cases treated with headless compression screws. Arthroscopic. After 6 months, the patient could resume normal sporting activities, and the knee joint extension and flexion were normal without knee instability and pain. Springerplus 2016;5:1164. Repair of displaced partial articular fracture of the distal femur: the. Difficulties involved in the Hoffa fractures [in German]. Biau DJ, Schranz PJ. [2]. Complications of anterior cruciate ligament reconstruction with bone-patellar tendon-bone constructs: care and prevention. [54] However, popliteal and gastrocnemius muscle traction and foot or ankle movement can lead to fracture redisplacement,[5557] which can cause delayed fracture healing, nonunion, traumatic arthritis, knee dysfunction, and other complications. Type 2 fractures require a . (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. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. [36]. [11,12] The bone marrow edema at the posterolateral aspect of the LFC suggest that the knee joint is highly flexed during patellar dislocation. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. [99]. Weight bearing is allowed with radiographic evidence of healing, which usually occurs by 10 weeks of the postoperative period.[55]. Please try after some time. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. [96]. Type III is an oblique fracture of the femoral condyle with the fracture line located anterior to the joint capsule, anterior cruciate ligament, lateral collateral ligament, popliteal tendon, and the lateral head of the gastrocnemius muscle. Two or 3 cancellous screws (4 or 6.5 mm) can be used to fix the fracture in an anterior-to-posterior direction. When patients have tenderness along the medial edge of patella and knee joint effusion, it is necessary to actively improve MRI examination, to rule out osteochondral injury. Primary traumatic patellar dislocation. Injury 2015;46:41921. Singh AP, Dhammi IK, Vaishya R, et al. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. Data is temporarily unavailable. Z Orthop Ihre Grenzgeb. -, Biau DJ, Schranz PJ. [104]. to maintaining your privacy and will not share your personal information without Egol KA, Broder K, Fisher N, et al. Lewis SL, Pozo JL, Muirhead-Allwood WF. 2003;19:71721. [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. Plate fixation for Letenneur type I. [33] Dua and Shamshery[34] proposed a classification method that supplements the AO classification with proper surgical planning to optimize outcomes. 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. Ul Haq R, Modi P, Dhammi I, et al. [76]. [51]. Twenty-seven-year nonunion of a. You may be trying to access this site from a secured browser on the server. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. Published by Wolters Kluwer Health, Inc. 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. Distal pulses and sensation were intact. For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors. 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 most common way to fracture the femoral condyles is jumping from a large height. 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. Careers. J Pediatr Orthop B, 2013, 22: 344349. 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. (C) CT examination of the left knee joint: the continuity of the subarticular bone of the lateral condyle of the left femur was interrupted. [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. official website and that any information you provide is encrypted [Treatment of extensive chondral defects of the patella after patellar dislocation]. 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). Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. [64]. [59]. Rosenberg NJ. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). Caton J, Deschamps G, Chambat P, et al. This site needs JavaScript to work properly. [27]. Your message has been successfully sent to your colleague. The patient felt pain in his right knee and limited movement. Intra-articular dislocation of the patella with associated, [26]. Nonunion of a, [62]. Coronal plane fracture of the femoral condyles: anatomy, injury patterns, and approach to management of the Hoffa fragment. An unusual fracture of the lateral femoral condyle in a child. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. J Pediatr Orthop. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. Medline, Embase, the Cochrane Library, Google Scholar, the China National Knowledge Infrastructure, and the China Biology Medicine disc were searched for relevant articles. [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. 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. J Orthop Trauma 2002;16:17881. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. Intertrochanteric femoral fractures occur mostly in the elderly, and the average age of onset is 66-76 years. 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. The Authors. Impact fractures are due to track formation and propagation. [57]. Preliminary X-ray examination showed osteochondral defects of LFC and loose body in knee joint (Fig. Dejour H, Walch G, Nove-Josserand L, et al. [40]. 2). [24]. Malunion: This happens when your broken bones don't line up correctly while they heal. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. Neglected. A patient, 15-year-old, female student. Cruciate fracture of the distal femur: the double. Rofo. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. [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. 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. Following Letenneur classification of coronal fractures of the femoral condyle in the 1970s and the publication of the second version of the Manual of Internal Fixation, the Hoffa fracture has become more widely recognized by orthopedists. The site is secure. 4). 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. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. [18]. HHS Vulnerability Disclosure, Help 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. [31]. After arthroscopic confirmation of Lateral Femoral Condyle (LFC) ostechondral fracture (HSL, Hill-Sachs-like Lesion) the anterolateral portal is enlarged to 2-3 cm. Rev Chir Orthop Reparatrice Appar Mot. Callewier A, Monsaert A, Lamraski G. Lateral. Onay T, Glabi D, olak , et al. The .gov means its official. Min L, Tu CQ, Wang GL, et al. The swashbuckler: a modified anterior approach for fractures of the distal femur. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). 1). 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%. Kini SG, Sharma M, Raman R. A rare case of open bicondylar, [67]. 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. Type II is a fracture horizontal to the base of the posterior condyle with fracture lines located posterior to the attachment point of the lateral collateral ligament. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. [43]. Distal femur fractures most often occur either in older people whose bones . Shetty GM, Wang JH, Kim SK, et al. Baker BJ, Escobedo EM, Nork SE, et al. Med Sci Monit, 2012, 18: CS117CS120. Objective: To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. [8]. Arthroscopy. Arthroscopy 2012;28:13817. Fracture and dislocation compendium: Orthopaedic Trauma Association Committee for Coding and, [35]. [78]. http://creativecommons.org/licenses/by-nc-nd/4.0. Please try after some time. Nonunion of a. Li et al[25] used absorbable suture to treat OCF caused by patellar dislocation and achieved good medium-term results. 2021 Jun 10;11(6):543. doi: 10.3390/life11060543. to maintaining your privacy and will not share your personal information without Wang JY, Liu Y, Li Y, et al. Bali K, Mootha AK, Krishnan V, et al. Paa L, Vesel R, Koi J, et al. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Operative, [46]. Redislocation in 37/75 patients followed for 6-24 years. [61]. At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: Reduce Pain Restore Movement Optimise Recovery What are Femoral Condyle Fractures? Many author think these injuries are caused by the impact between the patella and femoral condyle with a knee flexed over 90. [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. J Knee Surg. Two patients with osteochondral injury of the weight-bearing portion of the lateral. Conjoint bicondylar, [45]. [21] Matthewson et al[21] reported for the first time that patellar dislocation complicated with OCF of LFC was treated with early internal fixation and external fixation to avoid early weight bearing, and achieved good results. See this image and copyright information in PMC. [39]. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries. 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. Miyamoto R, Fornari E, Tejwani NC. Malays Orthop J 2017;11:204. Jarit GJ, Kummer FJ, Gibber MJ, et al. 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. [19]. Busam ML, Provencher MT, Bach BR. 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Oral application of Qiangguyin Keli and alendronate sodium vitamin D3 tablets in postoperative anti-osteoporosis. Search for Similar Articles Our hospital's institutional review board waived the need for ethical approval for this review paper. 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..
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