Surgical management of complex intra-articular distal femoral and bicondylar Hoffa fracture

Bicondylar Hoffa’s fractures of distal femur are rare. We report the case of an 18-year-old male who sustained a closed complex fracture of both femoral condyles of the left femur on the sagittal plane (Hoffa fracture), combined with distal metaphyseal fracture. He was treated using parallel plates and interdigitating screws, with our technique based on an extrapolation of the principles of distal humerus fixation. The fracture united clinically and radiologically at 16 weeks. Twelve months postoperatively, the range of movement in the knee was 5°–115°. In this complex case, our technique provided stable fixation of the fragments and a satisfactory final functional outcome.

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Failure analysis and recommendations for treatment of posttraumatic non-unions of the distal humerus during childhood

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01613-3 ◽

2021 ◽

Vol 47 (2) ◽

pp. 313-324 ◽

Cited By ~ 1

Author(s):

Dirk Walther Sommerfeldt ◽

Peter Paul Schmittenbecher

Keyword(s):

Failure Analysis ◽

Revision Surgery ◽

Distal Humerus ◽

Implant Removal ◽

Supracondylar Fractures ◽

Stable Fixation ◽

Non Union ◽

Pediatric Traumatology ◽

Clinical Cases

Abstract Purpose Non-unions of the distal humerus are rare complications of common children’s fractures such as radial condyle fractures and supracondylar fractures. The aim of this paper was to update the knowledge about etiology, reasons, management, and results of these troublesome, and sometimes debilitating entities. Methods The sparse literature concerning nonunions following condylar or supracondylar fractures was analyzed together with the presentation of some typical clinical cases. Results In most of the cases, non-unions were induced by neglect, unstable fixation, too early implant removal, too much revision surgery, and an inconsequent transfer of follow-up algorithms, or combinations of the above. Treatment of non-union should start as early as possible because the effort of required surgery increases with time that the nonunion has been neglected. Often a combination of stable fixation of the pseudarthrosis and correction of the elbow axis are necessary to achieve a satisfying outcome. Conclusion In pediatric traumatology, qualified and consequent care for children’s fractures of the distal humerus can prevent rare complications such as non-unions in almost any situation. If such a disturbance of healing is noticed, immediate and adequate, i.e. children specific surgical consequences achieve best results.

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Sagittal Plane Kinematics of Passive Dorsiflexion of the Foot in Adolescent Athletes

Journal of the American Podiatric Medical Association ◽

10.7547/1030394 ◽

2013 ◽

Vol 103 (5) ◽

pp. 394-399 ◽

Cited By ~ 1

Author(s):

Alfred Gatt ◽

Nachiappan Chockalingam ◽

Owen Falzon

Keyword(s):

Repeated Measures ◽

Sagittal Plane ◽

Random Order ◽

Adolescent Athletes ◽

Range Of Movement ◽

Kinematic Data ◽

Repeated Measures Analysis ◽

Foot Posture ◽

Foot Model ◽

Oxford Foot Model

Background: Although assessment of passive maximum foot dorsiflexion angle is performed routinely, there is a paucity of information regarding adolescents’ foot and foot segment motion during this procedure. There are currently no trials investigating the kinematics of the adolescent foot during passive foot dorsiflexion. Methods: A six-camera optoelectronic motion capture system was used to collect kinematic data using the Oxford Foot Model. Eight female amateur gymnasts 11 to 16 years old (mean age, 13.2 years; mean height, 1.5 m) participated in the study. A dorsiflexing force was applied to the forefoot until reaching maximum resistance with the foot placed in the neutral, pronated, and supinated positions in random order. The maximum foot dorsiflexion angle and the range of movement of the forefoot to hindfoot, tibia to forefoot, and tibia to hindfoot angles were computed. Results: Mean ± SD maximum foot dorsiflexion angles were 36.3° ± 7.2° for pronated, 36.9° ± 4.0° for neutral, and 33.0° ± 4.9° for supinated postures. One-way repeated-measures analysis of variance results were nonsignificant among the 3 groups (P = .70), as were the forefoot to tibia angle and hindfoot to tibia angle variations (P = .091 and P = .188, respectively). Forefoot to hindfoot angle increased with the application of force, indicating that in adolescents, the forefoot does not lock at any particular posture as portrayed by the traditional Rootian paradigm. Conclusions: Participants had very flexible foot dorsiflexion, unlike those in another study assessing adolescent athletes. This finding, together with nonsignificant statistical results, implies that foot dorsiflexion measurement may be performed at any foot posture without notably affecting results. (J Am Podiatr Med Assoc 103(5): 394–399, 2013)

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A Three-Dimensional Morphometrical Study of the Distal Human Femur

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1243/pime_proc_1992_206_282_02 ◽

1992 ◽

Vol 206 (3) ◽

pp. 147-157 ◽

Cited By ~ 42

Author(s):

M Zoghi ◽

M S Hefzy ◽

K C Fu ◽

W T Jackson

Keyword(s):

Distal Femur ◽

Sagittal Plane ◽

Femoral Condyle ◽

Three Dimensional ◽

Distal Portion ◽

Average Radius ◽

Anterior Portion ◽

Circular Arcs ◽

Straight Line ◽

Circular Base

The objective of this paper is to present a method to describe the three-dimensional variations of the geometry of the three portions forming the distal part of the human femur: the medial and lateral femoral condyles and the intercondylar fossa. The contours of equally spaced sagittal slices were digitized on the distal femur to determine its surface topography. Data collection was performed using a digitizer system which utilizes low-frequency, magnetic field technology to determine the position and orientation of a magnetic field sensor in relation to a specified reference frame. The generalized reduced gradient optimization method was used to reconstruct the profile of each slice utilizing two primitives: straight-line segments and circular arcs. The profile of each slice within the medial femoral condyle was reconstructed using two circular arcs: posterior and distal. The profile of each slice within the lateral femoral condyle was reconstructed using three circular arcs: posterior, distal and anterior. Finally, the profile of each slice within the intercondylar fossa was reconstructed using two circular arcs: proximal-posterior and anterior, and a distal-posterior straight-line segment tangent to the proximal-posterior circular arc. Combining the data describing the profiles of the different slices forming the distal femur, the posterior portions of each of the medial and lateral femoral condyles were modelled using parts of spheres having an average radius of 20 mm. The anterior portion of the lateral condyle was approximated to a right cylinder having its circular base parallel to the sagittal plane with an average radius of 26 mm. The anterior portion of the intercondylar fossa was modelled using an oblique cylinder having its circular base parallel to the sagittal plane with an average radius of 22 mm. Furthermore, it is suggested that the distal portion of the lateral femoral condyle could be modelled using parts of two oblique cones while the distal portion of the medial femoral condyle could be modelled using a part of a single oblique cone, all cones having their circular bases parallel to the sagittal plane. It is also suggested that the posterior portion of the intercondylar fossa could be modelled using two oblique cones: a proximal cone having its base parallel to the sagittal plane and a distal cone having its base parallel to the frontal plane.

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The ‘Sliding Meniscus’ Knee Prosthesis: Design Concepts

Engineering in Medicine ◽

10.1243/emed_jour_1979_008_049_02 ◽

1979 ◽

Vol 8 (4) ◽

pp. 201-205 ◽

Cited By ~ 6

Author(s):

R J Minns ◽

J Campbell

Keyword(s):

Femoral Component ◽

Sagittal Plane ◽

Knee Prosthesis ◽

Femoral Condyle ◽

Lower Surface ◽

Range Of Movement ◽

Design Concepts ◽

Final Design ◽

Movement Study ◽

Surface Examination

A ‘sliding meniscus’ knee prosthesis is proposed which includes design concepts as a consequence of biomechanical analyses undertaken. The biomechanical techniques included a range of movement study of the knee, knee force mechanics, mechanical testing, photoelastic studies and surface examination for loading and wear areas of the prosthetic components all of which led to a final design shape and size for a total knee joint replacement prosthesis. The prosthesis has a ‘polycentric’ femoral component which does not have to be precisely aligned in the femoral condyle; a tibial plateau which completely covers the cortex around the periphery of the tibia, horizontal alignment is necessary for this component; and four thicknesses of the sliding meniscus component which is congruent in the sagittal plane with the femoral component during load-bearing and flat on its lower surface for decreased wear and contact stress-levels.

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Long Term Evaluation of Radiographically Undetected Acute Osteomyelitis Resulting Chronic Osteomyelitis with MRSA

Medical and Health Science Journal ◽

10.33086/mhsj.v4i2.1546 ◽

2020 ◽

Vol 4 (2) ◽

pp. 91-96

Author(s):

Taufan Adityawardhana ◽

Sulis Bayusentono

Keyword(s):

Chronic Osteomyelitis ◽

Acute Osteomyelitis ◽

Open Biopsy ◽

Range Of Movement ◽

Laboratory Assessment ◽

Left Femur ◽

X Ray ◽

Her Family ◽

Abnormal Gait ◽

Left Limb

Osteomyelitis is an infection and inflammation of the bone that can spread into all parts of the bone. Methicillin-resistant Staphylococcus aureus or MRSA made the disease’s management far more complex and constrained and 28% of hospitals in Indonesia are suspected to be MRSA endemic. Osteomyelitis combined with MRSA have obscured prognosis knowing its assessment and management are still being developed. Presenting a case of Chronic Osteomyelitis and MRSA of 11-year old girl that has been monitored for 5 years after the reported onset since July 2015. The patient complained of severe pain in the left hip region causing her to stop using her left limb in July 2015. Signs of acute osteomyelitis couldn’t be confirmed by sequential assessments of X-Ray and USG examination. Cefazolin and Gentamicin injections were administered for 23 days. The family requested the patient to be sent home, due to no significant clinical improvement as indicated by them. Antibiotic regimens changed into oral regimens, which were Co-Amoxiclav and Gentamicin. The patient never appeared for routine check-up, her family conceded that they went to traditional alternative medication and stated the patient's clinical outcomes were showing signs of improvement; where the patient was able to walk normally. 6 months after, the patient's mother observed abnormal gait, however the patient didn't mention nor complain anything. X-ray assessment was then performed, with the result of the entire left femoral head being reportedly destroyed. In January 2016 the patient was referred to dr. Soetomo Academic General Hospital, the patient was diagnosed with chronic osteomyelitis and pathological fracture of 1/3 proximal left femur with a suspicion of avascular necrosis. The patient was given prophylactics antibiotics. Closed biopsy couldn't be performed hence open biopsy was suggested. The patient had routine check-ups to monitor the disease progression, alongside radiologic assessment and laboratory assessment prior to the operation. Episodes of localised swollen and tenderness in the hip area were accounted. Scenes of seropurulent discharges were additionally reported. In june 2017 patients had surgical debridement and sequestrectomy alongside an open biopsy, where MRSA was diagnosed. No antibiotics had been given after the surgery and the patient routinely washed up with Chlorhexidine Gluconate 4%. The patient still does routine check-ups at the outpatient facility, as radiologic and laboratory examination are routinely observed. As of now, the patient has no issue in its daily living activities. There is still limited range of movement at the infected site, with 90 degree of hip flexion and constrained internal rotation. A lower limb length discrepancy is present due to local growth aggravation at the left hip, currently patient using shoe with lift modifications on her left leg. In any case, there has been no complaint of pain, swollen or seropurulent releases throughout the last 18 months

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A PROSPECTIVE FOLLOW UP STUDY OF FUNCTIONAL OUTCOME OF SUPRACONDYLAR HUMERUS FRACTURE WITH INTERCONDYLAR EXTENSION TREATED WITH OLECRANON OSTEOTOMY APPROACH

10.36106/gjra/8702726 ◽

2021 ◽

pp. 76-79

Author(s):

Pradeep Choudhary ◽

Mahesh Bhati ◽

Ramniwas Bishnoi ◽

Aditya Srimal ◽

Jayesh Chouhan

Keyword(s):

Functional Outcome ◽

Distal Humerus ◽

Humerus Fracture ◽

Distal Humerus Fracture ◽

Range Of Movement ◽

Mayo Elbow Performance Score ◽

Humerus Fractures ◽

Distal Humerus Fractures ◽

Frequent Presence

Introduction- Olecranon osteotomy is standard approach for low transcondylar and intercondylar distal humerus fractures. Distal humerus fractures are difcult to manage successfully because of the local anatomic constraints, the frequent presence of comminution,displacement and osteopenia. We studied the functional outcome and complications following surgical xation using this approach. Material And Methods- A total 20 consecutive patients(male:15,female:5),having mean age 42.1yrs, of Distal Humerus fractures who will attend the casualty or O.P.D during the thesis period(June2018 to October2020) at Mahatma Gandhi Hospital & Mathuradas Mathur Hospital Jodhpur (Rajasthan) will be included in study group and managed surgically using olecranon osteotomy approach. Functional outcome was evaluated using the Mayo Elbow Performance Score(MEPS) and complications were observed. Results- Mean loss of extension was 10°.Mean exion achieved was 122.75°.Mean range of movement at treated elbow was 113°. All fractures united by the end of 3 months. Final results were excellent in 8 cases; good in 7 cases; fair in 4 and poor in one case. Most common complication in our study was discomfort due to hardware(6 cases). Supercial infection occurred in 2 cases. Screw/wire backout occurred in 2 cases. Elbow stiffness and malunion happened in one case. Functional outcome was also dependant on fracture subtype. Conclusion- Intraarticular distal humerus fracture treated with olecranon osteotomy approach had good articular exposure and surgical xation. This approach had good functional outcome and fewer complications.

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Double Parallel Plates Fixation for Distal Humerus Fractures

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2010.23.2.194 ◽

2010 ◽

Vol 23 (2) ◽

pp. 194

Author(s):

Young Hak Roh ◽

Moon Sang Chung ◽

Goo Hyun Baek ◽

Young Ho Lee ◽

Hyuk-Jin Lee ◽

...

Keyword(s):

Distal Humerus ◽

Parallel Plates ◽

Humerus Fractures ◽

Distal Humerus Fractures

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Atypical and incomplete pulmonary hypertrophic osteoarthropathy in the left distal femur: a case report

BMC Surgery ◽

10.1186/s12893-020-00959-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Gang Xu ◽

Norio Yamamoto ◽

Katsuhiro Hayashi ◽

Akihiko Takeuchi ◽

Shinji Miwa ◽

...

Keyword(s):

Bone Tumor ◽

Distal Femur ◽

Clinical Manifestations ◽

Large Cell Carcinoma ◽

Low Grade ◽

Hypertrophic Osteoarthropathy ◽

Imaging Features ◽

En Bloc ◽

Left Femur ◽

Laboratory Test Results

Abstract Background Pulmonary hypertrophic osteoarthropathy (PHO) is a rare paraneoplastic syndrome that mainly occurs in patients with lung cancer. Most symptoms occur symmetrically, and unilateral symptoms without clubbing are infrequent. This report presents the case of a rare atypical symptom that was highly suspected of being PHO. Case presentation A 77-year-old woman with swelling and severe pain in the left femur for 2 months was referred to our hospital. Radiography revealed a remarkably osteogenic thickening and sclerotic lesion in her distal femur. Preliminary diagnoses of malignant bone tumor and hematological tumor were made based on laboratory test results, radiological examination, and clinical manifestation. A needle biopsy was performed, which ruled out the diagnosis of malignant bone tumors. A low-grade bone tumor was still suspected. After that, en bloc resection was performed, followed by replacement of the femur with a mega-prosthesis. Pathological analysis revealed no malignant tumor cells, and immunohistochemical staining for CDK4 and MDM2 yielded negative results. Meanwhile, pulmonary large cell carcinoma was identified on biopsy. Based on published studies, a diagnosis of atypical PHO was made according to clinical and imaging manifestations. Conclusions This is an infrequent case of PHO with unilateral symptoms in the left femur. When clinical manifestations and radiological findings are inconsistent with the pathological results, the possibility of benign lesions with malignant clinical manifestations or imaging features should be carefully considered.

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Does posterior configuration have similar strength as parallel configuration for treating comminuted distal humerus fractures? A cadaveric biomechanical study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04302-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Chien-An Shih ◽

Fa-Chuan Kuan ◽

Kai-Lan Hsu ◽

Chih-Kai Hong ◽

Cheng-Li Lin ◽

...

Keyword(s):

Failure Modes ◽

Sagittal Plane ◽

Distal Humerus ◽

Biomechanical Study ◽

Posterior Fixation ◽

Fixation Failure ◽

Plate Group ◽

Failure Loads ◽

Humerus Fractures ◽

Distal Humerus Fractures

Abstract Background The posterior plating technique could be used as a clinical alternative to parallel plating for treating comminuted distal humerus fractures (DHFs) successfully with good clinical results. However, the biomechanical characteristics for posterior fixation are still unclear. The purpose of this study is to evaluate the biomechanical properties of the posterior fixation and to make comparisons between the parallel and the posterior fixation systems. Materials and methods We performed a cadaveric biomechanical testing with two posterior plating systems (a posterior two plating and a single posterior pre-contoured Y plating system) and one parallel two plating system to treat AO/OTA type-C2.3 DHFs. Among three groups, we compared construct stiffness, failure strength, and intercondylar width changes after 5000-cycle fatigue loading and failure loads and failure modes after destructive tests in both the axial compression and (sagittal) posterior bending directions. The correlations between construct failure loads and bone marrow density (BMD) were also compared. Results In axial direction, there were no significant differences in the stiffness and failure load between the posterior and the parallel constructs. However, in sagittal direction, the two-plate groups (posterior two plating and parallel plating group) had significant higher stiffness and failure loads than the one-plate group (single posterior Y plating). There was no fixation failure after 5000-cyclic loading in both directions for all groups. Positive correlation was noted between BMD and failure loads on parallel fixation. Conclusions We found that when using two plates for treating comminuted DHFs, there were no significant differences in terms of most biomechanical measurements between posterior and parallel fixation. However, the single pre-contoured posterior Y plate construct was biomechanically weaker in the sagittal plane than the parallel and the posterior two-plate constructs, although there was no fixation failure after the fatigue test for all groups regardless of the fixation methods. Level of evidence Biomechanical study

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Functional outcome of elbow joint in AO type 13C fractures treated with open reduction and internal fixation using dual plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191793 ◽

2019 ◽

Vol 5 (3) ◽

pp. 509

Author(s):

Uyyalawada Sreedhar Reddy ◽

Bheemsingh Samorekar ◽

Vinay J. Mathew ◽

Anil Kumar Mettu

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Distal Humerus ◽

Range Of Movement ◽

Excellent Outcome ◽

Significant Difference ◽

Dual Plating ◽

Type C ◽

A Prospective Study

Background: Distal end of the humerus, with its unique orientation of articular surfaces supported by a meagre amount of cancellous bone, makes its fracture a constant challenge to orthopaedic surgeons. Aim of the study is to evaluate the functional outcome of surgical management of intercondylar AO type C fractures of distal end of humerus using dual plating.Methods: A prospective study was conducted at our hospital between January 2015 to December 2016. Thirty five consecutive patients with intercondylar (AO Type C) fracture of distal humerus, included in study as per inclusion criteria. All patients were treated surgically using triceps reflecting approach and posterior trans-olecranon approach with ulnar nerve exploration and fixation using dual plating and tension band wiring for olecranon osteotomy wherever done.Results: In 35 patients, final results using MEPS scoring system excellent outcome is noticed in 15 patients (42.86%), good results is noticed in 13 patients (37.14%), fair result is noticed in 5 patients (14.29%) and poor result is noticed in 2 patients (5.71%). There was statistical significant difference in flexion range of movement arc at 2 and 6 months in our study.Conclusions: Open reduction and internal fixation of AO type 13C fractures is challenge to surgeon, preoperative planning and mastering the technique over a period of time gives good to excellent functional outcomes.

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