(A) MRI examination of the right knee joint: the bone continuity at the edge of the lateral condyle of the right femur was poor, the patchy high signal intensity was seen in the bone marrow cavity of the lateral condyle of the femur, and the local cartilage became thinner in the corresponding area. [100]. Analysis of functional outcome of Hoffa fractures: a retrospective review of 32 patients. Arthroscopy. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). 3 Although the examined patients were not professional athletes, some differences between these groups are worth mentioning: in the athletes, the medial rather than the lateral condyle was This kind of disease is commonly seen in the knee joint sprain during strenuous activity. Previous article . [10] Some of these patients may have a history of poliomyelitis that predisposes individuals to osteoporosis. [36]. Jabalameli M, Bagherifard A, Hadi H, et al. Correspondence: Wei Chen, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050051, China (e-mail: [emailprotected]). 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. (B) The sutures passing through the bone canal and the corresponding sutures on the anchor were tightened and fixed. J Orthop Surg Res 2012;7:21. At present, open reduction is often used to treat osteochondral fractures. The bone mass is missing at the fracture. Please try after some time. [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. Effectiveness of a footprint guide to establish an anatomic femoral tunnel in anterior cruciate ligament reconstruction: computed tomography evaluation in a cadaveric model. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. 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). Nork SE, Segina DN, Aflatoon K, et al. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. [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. [52] This fact reminds us that a Hoffa fracture evaluation should be a routine part of the lower-limb and pelvis examination with or without injury. [21,22], In some patients, a Hoffa fracture is associated with a patellar fracture. 3). Arthroscopic; Internal fixation; Osteochondral fracture; Suture anchor; TWINFIX Ti. J Bone Joint Surg Am 2006;88:22704. Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature. Fractures of the distal femur typically occur in the axial and sagittal planes. Egol KA, Broder K, Fisher N, et al. Irreducible, incarcerated vertical dislocation of patella into a. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Studies by Gesslein et al[22] show that open reduction and internal fixation of LFC with OCF is better than loose body removal. [97]. [14]. Monocondylar fractures of the femur: a review of 13 patients. Neglected. The funding sources have no role in study design, literature collection, review, data analysis, and manuscript preparation. (A) The fresh 1.5cm1.5cm fracture surface of the lateral condyle of femur was found under arthroscopy. Sahu RL, Gupta P. Operative management of, [44]. For more information, please refer to our Privacy Policy. Apropos of 128 cases]. [42] Compared with anteroposterior and lateral films, oblique radiographic views can show minimally displaced fractures better[14] and can, therefore, be used as a routine examination method for a Hoffa fracture. Unfallchirurg 2004;107:1521. Two patients with osteochondral injury of the weight-bearing portion of the lateral. Frangakis EK. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. (B) 1.5cm1.5cm free bone was found in the knee joint cavity, and the bone fracture was intact. 2001;17:5425. [4]. [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. 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. (A) One 1.5mm Kirschner wire temporarily fixed the fracture block of the lateral condyle of the femur. The site is secure. official website and that any information you provide is encrypted Bartonicek J, Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. [59]. Plain radiograph [53]. We prospectively documented all potential cases of non-weight-bearing posterior subchondral impaction fractures of the femoral condyles diagnosed on magnetic resonance imaging (MRI) of the knee performed at our institution between January 2006 and December 2011. Vivek T, Saubhik Da, Sahil G, et al. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. The functional and radiographic outcome were satisfactory at 18 months after operation. [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. [14,15] Diederichs et al[16] suggest that a first patellar dislocation is often treated conservatively, and loose body removal, microfracture and internal fixation should be selected according to the size and location of osteochondral block. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. Lateral radiographs of the affected knee were inspected for a . The most common way to fracture the femoral condyles is jumping from a large height. Fracture and dislocation compendium: Orthopaedic Trauma Association Committee for Coding and, [35]. [75]. [99] The patella may become incarcerated in the intercondylar fossa, wedged between the femoral condyles, or even rarely incarcerated in the Hoffa fracture. Chin J Traumatol 2011;14:1436. [43]. Fixation with headless screws can reduce the degree of cartilage injury. The patient was evaluated by the physical therapist 2 days after his injury. [17]. J Pediatr Orthop B, 2013, 22: 344349. absorbable internal fixation; dislocation of patella; femoral condyle; osteochondral fracture. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. Gesslein M, Merkl C, Bail HJ, et al. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. eCollection 2021 Jan. Uimonen MM, Repo JP, Huttunen TT, Nurmi H, Mattila VM, Paloneva J. Knee Surg Sports Traumatol Arthrosc. [92]. Life (Basel). 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. 2004 Jan-Feb;142(1):103-8. doi: 10.1055/s-2004-817655. [25] A cannulated screw combined with a plate is recommended in these cases. Moreover, even if the medial patellar retinaculum is strengthened, the patient still has symptoms such as anterior knee pain. [104]. Sasidharan B, Shetty S, Philip S, 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. A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. Knee Surg Sports Traumatol Arthrosc. computed tomography scan and magnetic resonance (MRI) examination of knee joint further confirmed loose body within the knee joint, osteochondral defect in weight-bearing area of LFC and avulsion of medial patellofemoral ligament (Fig. 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. 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. Distal femur fractures most often occur either in older people whose bones . A modified posterolateral approach for. The patient had no previous history of patella dislocation and pain around the knee. Partial weight bearing with crutches is started at 6 to 8 postoperative weeks. Somford MP, van Ooij B, Schafroth MU, et al. Heuschen UA, Gohring U, Meeder PJ. chauffeur fracture: intraarticular fracture involving radial styloid; Another type of distal radius fracture is the Lister's tubercle fracture. However, some patients had suture removal during the second arthroscopy because of suture irritation. 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. [56]. Baker BJ, Escobedo EM, Nork SE, et al. Appointments 216.444.2606. d Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Zhejiang, China. For tibial fractures, the use of bone plates or intramedullary nails is recommended if the condition of the local soft tissue is suitable. The patient had an uneventful postoperative recovery. According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. The authors have no funding and conflicts of interest to disclose. [100,101] To avoid damaging the cartilage in these cases, it is important to reduce the patella early and restore the patellofemoral joint stability by repairing the damaged medial soft tissues. Introduction. 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. Vaishya R, Singh AP, Dar IT, et al. -, Biau DJ, Schranz PJ. Reconstructive osteotomy for a malunited medial. 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. 1982;68:31725. Orthop J Sports Med. (D) Under knee arthroscopy, obvious fracture line of lateral condyle of bone and osteochondral fracture of the lateral femoral condyle can be seen. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. [19] Therefore, lateral condyle fracture is significantly more common than medial condyle fracture. 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. -, Enea D, Busilacchi A, Cecconi S, Gigante A. Latediagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. Please enable scripts and reload this page. Objective: To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. Comminuted fractures are caused by severe traumas like car accidents. -, Patel JM, Saleh KS, Burdick JA, Mauck RL. J Surg Case Rep 2012;2012:10. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. [25]. Int Orthop. J Bone Joint Surg Am 1974;56:4234. [64]. The swashbuckler: a modified anterior approach for fractures of the distal femur. Type I, the most common classification, is a vertical fracture line parallel to the posterior cortex of the femur and involves the entire condyle. [48]. Jarit GJ, Kummer FJ, Gibber MJ, et al. Emerg Radiol 2015;22:3378. [85]. However, Gavaskar et al[2] argued that no evidence confirms this correlation. Intra-articular dislocation of the patella. Viskontas DG, Nork SE, Barei DP, et al. We used anchor absorbable suture bridge to fix osteochondral mass, and obtained good functional and imaging results at the final follow-up. Impact fractures are due to track formation and propagation. 2). 2023 Jan;15(1):103-110. doi: 10.1111/os.13586. J Orthop Surg 2017;25:17. Cancellous screws cannot achieve adequate compression[55] and require more surgical time to countersink. Musculoskelet Surg 2012;96:4954. [10] Werner and Miller [11] reported that iatrogenic injury is a cause of Hoffa fracture . A case report. In the anteroposterior radiograph of the femoral condyle, the trabecular bone structure of the femoral condyles is disordered, with poor continuity of the cortex. Zhou S, Cai M, Huang K. Treatment of. Seeley MA, Knesek M, Vanderhave KL. Bali K, Mootha AK, Krishnan V, et al. The specific mechanism of a Hoffa fracture is not well understood. Data is temporarily unavailable. The risk of blood vessel damage when using this approach is minimal but the common peroneal nerve should be isolated first. For Letenneur II and some Letenneur III fractures close to the posterior cortex of the femoral condyle, cannulated lag screw fixation is commonly used. Please try again soon. your express consent. Many author think these injuries are caused by the impact between the patella and femoral condyle with a knee flexed over 90. According to the internal fixation principle, the antiglide plate should be fixed in the posterior position. Incarcerated patellar tendon in. Ozturk A, Ozkan Y, Ozdemir RM. This article reviews the mechanism, diagnosis, classification, and treatment of Hoffa fractures. may email you for journal alerts and information, but is committed When high-energy trauma involves the distal femur, the lateral condyle is often damaged[18] before the medial condyle because of the physiologic genu valgum of the knee joint. After arthroscopic confirmation of Lateral Femoral Condyle (LFC) ostechondral fracture (HSL, Hill-Sachs-like Lesion) the anterolateral portal is enlarged to 2-3 cm. One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. The incidence ratio in male and female patients is in the range . J Bone Joint Surg Am 2008;90:46370. Acute patellar dislocation in children and adolescents: a randomized clinical trial. 2021. In these cases, avulsion of the anterior cruciate ligament along with a large chunk of bone at its insertion[17] can lead to a Hoffa fracture. Tan Y, Li H, Zheng Q, et al. A radiographic examination should include anteroposterior, lateral, oblique, and stress views of the knee. In addition, the Hoffa fracture line can be seen on stress films taken with the patient under general anesthesia. In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. [95]. Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout: a cadaveric study. [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. [4]. Agarwal S, Giannoudis PV, Smith RM. Complained of swelling and pain of the right knee after spraining during sports activities, demonstrated painful limited motion. 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. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. 2018;31:38291. Bethesda, MD 20894, Web Policies 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. deep lateral sulcus sign - depression of lateral femoral condyle representing impaction fracture anterior tibial translocation sign Segond fracture arcuate fracture joint effusion CT Considered to have high specificity and sensitivity in detecting anterior cruciate ligament disruption 6. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. Matthewson MH, Dandy DJ. [84]. Operative. [39,40] Wagih[41] reported that, under general anesthesia, patients with Hoffa fracture have instability at 30 of flexion but not with leg straightened. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging. Hoffa fractures are caused by shear stress between the femoral condyle and tibial plateau. An attempt to treat Hoffa fractures under arthroscopy: A case report. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. 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. Coronal fractures of the lateral femoral condyle. 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. Nonunion of a. [9]. 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. Lal H, Bansal P, Khare R, et al. Allmann KH, Altehoefer C, Wildanger G, et al. [98]. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. to maintaining your privacy and will not share your personal information without [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]. http://creativecommons.org/licenses/by-nc-nd/4.0. 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. 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. government site. Internal fixation with lag screws plus an antigliding plate for the, [88]. Epub 2022 Nov 15. 2003;19:71721. Suture anchor system is mostly used to repair rotator cuff and patellar tendon. During the operation, we found that 2.5*2. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. Screw insertion direction differs among operative approaches. View Large Image Download Hi-res image Download (PPT) White EA, Matcuk GR, Schein A, et al. Smith EJ, Crichlow TP, Roberts PH. Marzouki A, Zizah S, Benabid 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. In the AO classification, Hoffa fracture is classified as type B3.2. Medicine (Baltimore). Hoffa nonunion, two cases treated with headless compression screws. 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. Open bicondylar, [23]. -. 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. [105]. Westmoreland GL, McLaurin TM, Hutton WC. 1994;2:1926. Non-union coronal fracture femoral condyle, sandwich technique: a case report. Zeebregts CJ, Zimmerman KW, ten Duis HJ. Ji G, Wang S, Wang X, et al. Goel A, Sabat D, Agrawal P. Arthroscopic-assisted fixation of, [13]. eCollection 2020 Jun. Lee SY, Niikura T, Iwakura T, et al. Epub 2020 Sep 18. Efficacy of multiple Acutrak hollow head compression screws in the, [68]. [27]. Ann Chir 1978;32:2139. Some error has occurred while processing your request. Epub 2007 Mar 23. classification; diagnosis; Hoffa fracture; injury mechanism; treatment. The patient felt pain in his right knee and limited movement. 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). Hingelbaum S, Best R, Huth J, et al. 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 . [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. As the knee is being extended and in full extension, it can be seen that femoral and tibial surfaces do not articulate with each other. (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. Soft tissues are retracted to . Bauer KL. Xu Y, Li H, Yang HH, et al. [21]. 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.) [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. Rosenberg NJ. The CT classification[32] uses the anatomic femoral axis and a line parallel to the posterior cortex of the femoral condyle to divide the femoral condyle into a, b, and c regions. Soni A, Sen RK, Saini UC, et al. [61]. 5 and 6), and the lysholm score was 95 points, which was very good. Received: 27 October 2022 / Received in final form: 8 November 2022 / Accepted: 9 November 2022. Headless compression screws are self-compressing and can be positioned beneath the outer cortex resulting in significantly greater axial compression, a higher load limit, and increased fracture stability. Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. (B) MRI examination of the right knee joint: a patchy bone signal was seen in the anterior and lower part of the distal femur. Buttress plating for a rare case of comminuted medial condylar. Arthroscopy 2011;27:81724. [6]. Supervision: Qingxian Wang, Zhiyong Hou, Wei Chen. Careers. Fracture lines are often located where the anterior cruciate ligament and lateral collateral ligaments attach. Clinical outcomes after absorbable suture fixation of patellar, [26]. 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. FIGURE 1. J Orthop Trauma 1994;8:1426. [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. [6]. In addition, the lateral antiglide plate can provide stable support, and in combination with autologous bone grafting can promote fracture healing,[38,55,89] which is especially useful for treating old Hoffa fractures. [Patella infera. However, in recent years, some authors[35] reported OCF involving the weight-bearing area of LFC. [51]. Open reduction and internal fixation are preferred. Please enable it to take advantage of the complete set of features! [23]. Shah JN, Howard JS, Flanigan DC, et al. [42]. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected. [79]. Bicondylar. Bilateral. For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles[71] to allow proper reduction. The Letenneur classification, computed tomography (CT) classification, the AO classification, and the AO classification with supplement are widely used in clinics to categorize Hoffa fractures. 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. Nandy K, Raman R, Vijay RK, et al. Internal fixation with headless compression screws and back buttress plate for. [12,13] Most researchers[2,7,14] currently believe that when the knee is in 90 of flexion and emergency braking is performed while driving a car, an axial force in either a varus or valgus direction is transferred from the proximal femur to the femoral condyle. 2013;37:238594. Sun H, He QF, Huang YG, et al. The authors have no conflicts of interest to disclose. Surgical versus nonsurgical treatments of acute primary patellar dislocation with special emphasis on the MPFL injury patterns. Ercin E, Baca E, Kural C. Arthroscopic. In such cases, the forces necessary for closed reduction can result in cartilage injury or a small avulsion fracture of the patella. 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. Introduction. Xray examination of right knee joint: free bone mass can be seen at the anterior edge of the femur in the knee joint. Dave LY, Nyland J, Caborn DN. Ul Haq R, Modi P, Dhammi I, et al. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. Technique of reduction and fixation of unicondylar medial, [70]. Your message has been successfully sent to your colleague. [82]. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. Injury 1989;20:3714. PMC Cartilage. Maenpaa H, Huhtala H, Lehto MU. Acta Chir Orthop Traumatol Cech. 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. J Orthop Trauma 2006;20:2736. [60]. [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.
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