Ipsilateral lateral condyle Hoffa's fracture with PCL avulsion fracture and lateral tibial condyle osteochondral fracture
Score and Comment on this Case
Clinical Details
Clinical and radiological findings: History of head-on collision with another two-wheeler motorbike. Closed injury. Preliminary X-rays show lateral femoral Hoffa's fracture with a large PCL avulsion fragment. CT images (of poor resolution) showed two large fragments around PCL insertion.
Preoperative Plan
Planning remarks: ORIF of Lateral condyle Hoffa's with CC screws and anti-glide plate -- via anterolateral parapatellar approach ORIF of PCL avulsion with pull-out sutures (posterior to anterior), secured anteriorly over suture disc/bony bridge
Surgical Discussion
Patient positioning: Lateral decubitus for fixation of Hoffa's, Followed by prone position for PCL avulsion fixation
Anatomical surgical approach: Distal femur - Anterolateral parapatellar approach; Proximal tibia - posteromedial Burk-Schaffer approach
Operative remarks:In addition to the PCL avulsion fragment, there was a large osteochondral fragment from the medial half of lateral tibial condyle. It was reduced and fixed with headless screws.
PCL avulsion fragment was reduced with a pull-out suture -- with the AP tunnel placed using a PCL jig in reverse -- for control of tunnel trajectory.
Postoperative protocol: Non-weight bearing for 6 weeks. Bed-side ROM from day 1 as tolerated. Static quads.
Orthopaedic implants used: Distal radius 3.5 mm LCP, 4 mm fully threaded CC screws, 2.7 mm headless screws, suture disc
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Article viewed 880 times
20 Feb 2023
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Full Citation
Cite this article:
-. (2023). Ipsilateral lateral condyle Hoffa's fracture with PCL avulsion fracture and lateral tibial condyle osteochondral fracture. Journal of Orthopaedic Surgery and Traumatology. Case Report 46851968 Published Online Feb 20 2023.