Hoffa fracture
Definition
Coronal plane fracture of distal femoral condyle
- intra-articular
- often only attachment is posterior capsule
Epidemiology
Rare
Mechanism
Usually a severe valgus trauma
Xray
Coronal plane fracture of distal femoral condyle
- intra-articular
- often only attachment is posterior capsule
Rare
Usually a severe valgus trauma
Education regarding shoe wear
- extra wide / large toe box
Insoles
- longitudinal arch support
- pre MT dome for metatarsalgia
- podiatry to attend to callosities
Toe spacers
Analgesia
1. Continued pain and discomfort
2. Difficulties with shoe wear
Return to Sport
Shelbourne et al. Am J Sports Med 1999
- 133 patients with isolated PCL injuries followed for mean of 5 years
- 1/2 returned to sport at same level of play
- 1/3 returned to sport at lower level of play
https://pubmed.ncbi.nlm.nih.gov/10352760/
Agolley et al. Bone Joint J 2017
Fracture below lesser trochanter / proximal 5 cm femur
Young patients / high velocity injuries
Old patients / osteoporosis
Under-riding toe
- toe lies beneath adjacent toe
- congenital deformity
Due to tight FDL & FDB
- capsule initially normal
- becomes constricted with time
Usually 3rd toe
- flexed, ER, medially deviated
Deformity accentuated when standing
Ankle dorsiflexion
The coronoid is the most important portion of ulno-humeral articulation
Reasons
1. Provides anterior buttress
2. Anterior capsule and brachialis attach to coronoid
2. Anterior band of the MCL attaches to it
- distally and medially on sublime tubercle
Massive tear
1. > 5cm
- retracted to humerus / glenoid margin
2. At least 2 complete tendons
- lose SS / IS or SS / SC
1987 American College of Rheumatology
Need 4/7 (MAX RANS)
1. Morning Stiffness
2. Arthritis of 3 areas > 6/52
3. Xray changes
4. Rh factor
5. Arthritis of Hand > 6/52
6. Nodules
7. Symmetric Arthritis > 6/52
Natural History of ACL deficient knee is variable
- functional instability 15% - 90%
- progression to OA is variable
Depends on level of patient demands / activity
1. Late meniscal injury in ACL deficient knee
15-25%
2. Function
Daniels Am J Sports Med 1994
- 292 ACL defecients knees
Corn
- accumulation of keratotic layers of epidermis
- thickened epithelium elevates prominence causing further pressure
Hard Corn
Due to extrinsic pressure from footwear
- most common on lateral aspect of 5th toe
- over head of proximal phalanx
Soft Corns
- on the condyle of proximal phalanx between the toes