11 (2):117-20. Fracture separation of the distal humeral epiphysis in children younger than three years old. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. Osteonecrosis of the knee occurs most often in the medial femoral condyle, a segment of bone located at the lower end of the femur (thighbone). Clin. Accessibility At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: Reduce Pain Restore Movement Optimise Recovery What are Femoral Condyle Fractures? Swelling can occur and bruising in many cases. 1996 Jul-Sep;63(7-8):475-9. Management of nonunion of humeral medial condyle fracture: A case series and review of the literature. Femoral condyle fractures due to . If the patient is unable to tolerate a long surgical procedure because of polytrauma, closed reduction and cast immobilization with 90 of flexion is an option. Femoral medial condyle fracture is a rare fracture. [QxMD MEDLINE Link]. Osteochondral Injuries of the Knee in Pediatric Patients [QxMD MEDLINE Link]. 16 (2):117-23. Iowa Orthop J. Informed consent was obtained for the surgery. MeSH It is our goal to provide the highest level of care and service to our patients. International Journal of Surgery Case Reports. Additionally, they might recommend for you to use supportive braces or belts. As with any fracture reduction, periosteum and bone fragments are cleared from the fracture site to allow anatomic reduction. Before 1965 Jul-Aug. 41:43-50. Clinical outcomes were variable, with 23.9% (11/46) requiring TKA. Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. Osteoarthr. The anatomical plate for distal medial condyle fracture of femur should be developed as soon as possible. Unable to process the form. Diagnosis is made radiographically with CT studies often required to assess for intra-articular extension. Would you like email updates of new search results? The patient shared her perspective on the treatment when her wound was healed completely. Medial Condylar Fracture of the Elbow Treatment & Management Several closed means of reduction can be used, and the success rate with these methods approaches 40%. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. Ulus Travma Acil Cerrahi Derg. Most commonly, this is ensuring that the ACL is intact. MeSH 2007;14 (2): 112-6. A loss of elbow extension of 10-15% can be expected in up to 20% of cases, and this appears to be correlated more with prolonged immobilization than the fracture itself. This immobilization must be balanced against the need for physical therapy to prevent loss of ROM. 1972 Nov. 4 (2):171-4. One such maneuver (the Roberts manipulative technique) is performed under sedation and involves placing a valgus stress on the elbow while supinating the forearm and simultaneously dorsiflexing the wrist and fingers to place the forearm flexor muscles on stretch. Anteroposterior view of displaced medial epicondyle fracture. 28 (2):2309499020921755. Branches of the medial antebrachial cutaneous nerve should be identified and preserved. [QxMD MEDLINE Link]. 2002 Jan-Feb. 22 (1):2-7. Cartil. She did not present loss of consciousness, central nervous system dysfunction, or paralysis. 7. In fractures with a vertical fracture line, a buttress plate is necessary to counteract the vertical shear forces. This type of transfer is also best in small defects It may be used when a microfracture may not be indicated, such as in patients who have bone cysts below a small area of a cartilage defect. Before The patient had an uneventful postoperative recovery. Injury. Hoppenfeld S, Murthy VL. Microfracture procedures are best indicated for small and well localized defects, commonly those that are 1 cm or less in size and have normal bone surfaces below the defect. Curr Opin Pediatr. An official website of the United States government. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The current gold standard is a fresh osteoarticular allograft. Atlas Oral Maxillofac Surg Clin North Am. J Bone Joint Surg Am. As it is a high-energy injury it will often be seen with other injuries of the knee. The blood supply to the epiphysis is through the soft-tissue attachments at the medial epicondyle. Bethesda, MD 20894, Web Policies Ramnath RR, Kattapuram SV. Immediate treatment will need to be at the emergency room. By definition,secondary osteonecrosis of the knee occurs secondary to an insult. Inclusion in an NLM database does not imply endorsement of, or agreement with, Acta Orthop Scand. 2015 Feb. 27 (1):58-66. Unable to load your collection due to an error, Unable to load your delegates due to an error. [QxMD MEDLINE Link]. The medial aspect of the knee, and specifically the descending genicular artery (DGA), was first recognized as a potential donor site for a vascularized flap in 1981 [].In 1985, the osteoarticular branch (OAB) of the DGA was realized as a flap supply source in harvesting the adductor magnus tendon and tubercle [].The contemporary medial femoral condyle (MFC) flap was first described in 1988 as . Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. In many studies, including long-term follow-up reports, patients treated nonsurgically had results similar to those of patients treated surgically, even for fracture fragments displaced as much as 15 mm. Please let our friendly reception staff know the background and severity of your condition. Traumatol. 2010 May. An 80-year-old woman was brought to our hospital with severe right knee pain after falling down 15 steps at her home. This could also be described as chondromalacia which is basically a kind term for arthritis. Gorbachova T, Amber I, Beckmann NM, Bennett DL, Chang EY, Davis L, Gonzalez FM, Hansford BG, Howe BM, Lenchik L, Winalski CS, Bredella MA. Plain radiography and computed tomography showed oblique fracture of the femoral medial condyle. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. 1982 Jan. 7 (4):239-49. Fractures of the medial condyle and epicondyle of the elbow in children. 3/58 Oldfield Road, Sinnamon Park Qld 4073, Elbow MCL (Medial Collateral Ligament) Sprain, Stiffness/inability to move the knee joint, Inability/extreme difficulty to weight bear on the knee/leg, Instability feels like the joint is slipping out of place, Stretching, strengthening and/or conditioning exercises. Recognizing that spontaneous osteonecrosis of the knee was a misnomer and actually represents a subchondral insufficiency fracture that progressed to subchondral collapse with secondary osteonecrosis,the Society of Skeletal Radiology Subchondral Bone Nomenclature Committee recommended that "subchondral insufficiency fracture" be the preferred term 17. Misdiagnosis or delay in diagnosis or treatment increases the risk of impairment and complications. Kirschner wires (K-wires) or cancellous screws may be used. 7 Subchondral fractures also occur in the lateral femoral condyle or tibial plateau. Breer S, Oheim R, Krause M et-al. 3. Br J Oral Maxillofac Surg. Resistance of four fixation techniques used to treat subcondylar fractures. Case report, Femoral medial condyle fracture, Proximal tibial plate, Surgery, Knee. The two main complications associated with medial epicondyle fractures are as follows: The first major complication with an unrecognized medial epicondyle fracture involves loss of motion secondary to impingement of the fragment. 1990;154 (2): 331-6. Accessibility [QxMD MEDLINE Link]. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 9. 1. Medial epicondyle fractures also may be treated in a closed fashion if the medial epicondyle is nondisplaced, minimally displaced, or even displaced up to 15 mm (see the image below). The presence of blood and glistening fat globules indicates lipohemarthrosis, which is pathognomonic for intraarticular knee fracture.</p> <p>Document the neurovascular status. Radiology of postnatal skeletal development. Concomitant medial condyle fracture of the humerus in a childhood posterolateral dislocation of the elbow. Tarallo L, Mugnai R, Fiacchi F, Adani R, Zambianchi F, Catani F. Pediatric medial epicondyle fractures with intra-articular elbow incarceration. Dakar Med. As with any articular injury, anatomical restoration of the joint surface must be obtained, then lag screw fixation is required. Dependant on the injury the fracture may be close, meaning the skin is not broken or, open where the bone protrudes through the skin. The patient had an uneventful postoperative recovery. Femoral Condyle Cartilage Defect Treatment: Treatment of cartilage defects of the femoral condyles requires a thorough workup and ensuring that the defects are truly symptomatic. It is almost always unilateral, usually affects the medial femoral condyle (but can occasionally involve the tibial plateau 9) and is often associated with a meniscal tear. The https:// ensures that you are connecting to the Edina, MN 55435, EAGAN-VIKING LAKES OFFICE Discussion: Although subchondral impaction fractures have already been reported in the non-weight-bearing portion of the lateral femoral condyle, this study reveals the presence of an intra-articular impaction fracture of the postero-superior region of the non-weight-bearing portion of the medial femoral condyle recognized in 5 of a group of . Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). [Posttraumatic temporomandibular joint ankylosis: clinical development and surgical management]. J Orthop Traumatol. HHS Vulnerability Disclosure, Help Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. MeSH The locking compression plate for proximal tibia is an acceptable solution for femoral medial condyle fracture. Patel NM, Ganley TJ. J Trauma. The femur has another articulation with the patella, called the patellofemoral joint. 30 (3):253-63. Femoral Condyle Fractures are a painful condition which can result from trauma injuries to the thigh bone and/or knee. Harrison RB, Keats TE, Frankel CJ, Anderson RL, Youngblood P. Radiographic clues to fractures of the unossified medial humeral condyle in young children. J Am Acad Orthop Surg. Dodds SD, Flanagin BA, Bohl DD, DeLuca PA, Smith BG. Thank you for choosing Dr. LaPrade as your healthcare provider. HHS Vulnerability Disclosure, Help Nevertheless, there are no available anatomical plates that fit either the femoral medial condyle or fracture fixation, except for the relatively short plate developed for distal femoral osteotomy. Surg. Whether this is best performed during growth or after the physis has closed has not yet been determined. Careers, Unable to load your collection due to an error. Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: Is dual plate fixation necessary? -, Agha R.A., Borrelli M.R., Farwana R., Koshy K., Fowler A., Orgill D.P., For the SCARE Group The SCARE 2018 statement: updating consensus surgical CAse REport (SCARE) guidelines. 2003 Aug;13(8):1843-8. doi: 10.1007/s00330-002-1775-6. The femoral condyles are the lower part of the femur where the shaft widens to two condyles, one medial and one lateral. The patient complained of severe pain in the right knee and could not move her knee. If you have fractured your femoral condyles, it is important to seek out immediate medical treatment. Subchondral insufficiency fracture of the knee. Here, we present a case with femoral medial condyle fracture treated with a proximal tibial plate. Materials and methods Medscape Education. Similar functional results have been reported with operative and nonoperative surgical management. Past reports have shown the possibility of screw fixation plating for the fracture [2,[6], [7], [8], [9], [10]]. 2003. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). At the time the article was created Frank Gaillard had no recorded disclosures. National Library of Medicine and transmitted securely. This paper has been written in line with the SCARE criteria . [QxMD MEDLINE Link]. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. 1995 Jul-Aug. 15 (4):444-8. Subchondral impaction fractures of the non-weight-bearing portion of the lateral femoral condyle. Careers. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! When the cartilage defect is more localized, surgery may be indicated. Reduced fragment is marked. Some have advocated operative treatment of high-demand athletes, on the grounds that even minor amounts of valgus instability can result in significant disability. J Bone Joint Surg Br. 11. For bicondylar fractures, a median parapatellar incision can be used. Epub 2018 Jan 17. Supracondyle wedge osteotomy has been advocated to restore anatomic angulation and motion loss from previous injury. Epub 2013 Sep 7. The only absolute indications for operative management of closed medial epicondyle fractures are the following: An incarcerated fragment within the joint must be removed. Cavalieri-Pereira L, Spagnol G, Sverzut CE, de Moraes M, Trivellato AE. 2013;21 (2): 340-5. [QxMD MEDLINE Link]. Authors declare there are no funding resources for this paper. sharing sensitive information, make sure youre on a federal 2013 Nov;25(4):661-81. doi: 10.1016/j.coms.2013.07.006. Murphy C.G., Chrea B., Molloy A.P., Nicholson P. Small is challenging; distal femur fracture management in an elderly lady with achondroplastic dwarfism. The femoral condyles articulate, or contact, with the tibia and on the medial side this is in the medial tibial plateau and the medial meniscus and on the outside of the knee is known as the lateral tibial plateau in the lateral meniscus. For more information on femoral condyle conditions and the available treatment options for your knee pain, please contact the offices of Dr. Robert LaPrade, serving patients from the Twin Cities, Minneapolis-St. Paul, Edina and Eagan, MN. 2022 Mar;53(3):1237-1240. doi: 10.1016/j.injury.2021.11.034. [QxMD MEDLINE Link]. 1 While BME can occur in any bone, the legs are most often affected. Court-Brown C.M., Caesar B. Pape D, Seil R, Kohn D et-al. At Vitalis Physiotherapy, our treatment of femoral condyle fractures aims to: The knee comprises of the thigh bone (femur), the kneecap (patella) and the shin bone (tibia) joining together. The site is secure. Treatment can either be operative or non-operative, with initial treatment often conservative and consisting of analgesia and protected weight bearing. Plain radiography and computed tomography showed oblique fracture of the femoral medial condyle. He offers. Report of two cases. Ochi J, Nozaki T, Nimura A, Yamaguchi T, Kitamura N. Subchondral Insufficiency Fracture of the Knee: Review of Current Concepts and Radiological Differential Diagnoses. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). It accounts for only about 5% of fracture to the femur, and that is less than 0.5% of all fractures. Management of condylar fractures - PubMed Anteroposterior view of displaced medial epicondyle fracture after reduction. lt=""-/W3C/DTD XHTML 1.0 Strict/EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-s" title=""-/W3C/DTD XHTML 1.0 Strict/EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-s">. J Orthop Trauma. [Full Text]. 2004;35 (3): 365-70, x. The plate was bent to fit the bone surface and fixed with cortical and locking screws. 2004 May;33(5):260-4. doi: 10.1007/s00256-004-0751-4. Hoffa fractures can be of one condyle or can be bicondylar, and are categorised as type 1,2 and 3 depending on the angle of the fracture line, and with letter a,b and c, denoting the region of the femoral condyle that the fracture is in. Contact us to make an appointment. National Library of Medicine 1987 Jan-Feb. 7 (1):54-60. Moore KL, Dalley AF, Agur AMR. Heterotopic ossification can result in severe loss of flexion and extension. [QxMD MEDLINE Link]. 16. At the time the article was last revised Yuranga Weerakkody had Femoral medial condyle fracture is a rare fracture. Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. official website and that any information you provide is encrypted Skeletal Radiol. the contents by NLM or the National Institutes of Health. Microsurgery. J Pediatr Orthop. In fact 2 years ago I finished climbing the top 100 peaks in CO. Bookshelf Jpn J Radiol. As with any articular injury, anatomical restoration of the joint surface must be obtained, then lag screw fixation is required. Bensahel H, Csukonyi Z, Badelon O, Badaoui S. Fractures of the medial condyle of the humerus in children. Incarcerated medial epicondyle fracture following pediatric elbow dislocation: 11 cases. Bethesda, MD 20894, Web Policies A large bone fragment was identified attached to the MCL, of which the MCL is intact. Eur J Trauma Emerg Surg. 2019 Aug. 45 (4):757-761. Res. Ann R Coll Surg Engl. The fracture surfaces are identified and cleaned, and the joint space is cleaned and irrigated to remove loose particles. The innervation of the medial humeral epicondyle: implications for medial epicondylar pain. Please enable it to take advantage of the complete set of features! Traumatol. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Jegan Krishnan, MBBS, FRACS, PhD is a member of the following medical societies: Australian Medical Association, Australian Orthopaedic Association, Royal Australasian College of SurgeonsDisclosure: Nothing to disclose. Chacha PB. Edmonds EW. If the epicondyle is fragmented, excision of the fragment and fixation of the flexor-pronator origin and medial collateral ligament (MCL) to bone with an alternative form of fixation (eg, suture anchors) may be used. This was treated with a supracondylar wedge osteotomy to restore ROM and correct the cubitus varus deformity. Imaging showed failure of the medial femoral condyle to incorporate with talar fragmentation. official website and that any information you provide is encrypted Hoffa fracture of the femoral condyle: Injury mechanism, classification Surgical techniques and a review of the literature. 4010 W. 65th St. Surgical intervention may be recommended as a method of treatment whether that be the insertion of pins to stabilise the joint, to a complete knee replacement. In more advanced cases, subchondroplasty (where a bone substitute is injected) may be considered. Copyright 2020 The Author(s). [QxMD MEDLINE Link]. Intraobserver and interobserver agreement in the measurement of displaced humeral medial epicondyle fractures in children. Functionally, no limitation from this radiographic finding appears to exist. Bjrkengren AG, Alrowaih A, Lindstrand A et-al. Nonunion On examination, bruising and tenderness were present on her head, back, right hip, right knee, and left shoulder. We recommend a consultation with a medical professional such as James McCormack. [Full Text]. John J Walsh, IV, MD Professor and Chairman, Department of Orthopedic Surgery, University of South Carolina School of Medicine Two patients had a history of osteoporotic fractures, one had laboratory test evidence of osteomalacia and one had recurrent insufficiency fractures mistakenly ascribed for several years to migratory transient osteoporosis. Injury. Primary osteonecrosis of the femoral condyle shares several features with insufficiency fractures, including predominance in elderly women with factors responsible for mechanical stress (varum, obesity, trivial trauma), mechanical pain, and increased radionuclide uptake. PMC for: Medscape. How displaced are "nondisplaced" fractures of the medial humeral epicondyle in children? Knee Pain Location Chart Muscles of the Knee Hoffa Fat Pad, This is not medical advice. 2. 6. Disclaimer. The proximal tibial plate could become the method of choice for such fractures. 1971 Sep. 53 (6):1102-4. Careers. At the latest follow-up, the patient achieved a range of motion of 0 to 120 and could walk without pain. This paper reports just the record of patient treatment. J Pediatr Orthop. A posterior splint is then applied for at least 7-10 days until ROM is initiated. The https:// ensures that you are connecting to the Physical therapy is also highly beneficial in rehabilitating the structures around the knee after a fracture to increase range of movement and strength. The sagital plane is a vertical plane that runs from front to back and decides the body from side to side. 2004;33 (10): 575-81. The force of this event may even fracture other bones within the knee or legs. Mochizuki Y, Yamamoto N, Noda T, Ozaki T. Acta Orthop Traumatol Turc. Dellon AL, Ducic I, Dejesus RA. Our clinics are open: J Orthop Surg (Hong Kong). For nondisplaced or minimally displaced medial epicondyle fractures, nonoperative management is the procedure of. This also can result from premature closure of the physis. Pathy R, Dodwell ER. 2000;82 (6): 858-66. To our knowledge there have been no previous reports of stress fractures of the medial femoral condyle. Epub 2021 Nov 18. Unauthorized use of these marks is strictly prohibited. . The site is secure. These surgeries certainly may be indicated in some areas, but the gold standard is still the fresh osteoarticular allograft if possible. IS attended the surgery, and all authors read this paper. Impaction Fracture of the Medial Femoral Condyle assessment of the anterior cruciate liga-ment with the anterior drawer and Lach-man tests was negative for laxity. A longitudinal incision is made over the medial supracondyle ridge of the humerus and continued just distal to the medial condyle. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-2079, View Frank Gaillard's current disclosures, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, Spontaneous osteonecrosis of the knee (SONK), Spontaneous osteonecrosis of the knee (SPONK), Spontaneous insufficiency fracture of the knee (SIFK), Subchondral insufficiency fracture of the knee (SIFK). Penny P, Swords M, Heisler J, Cien A, Sands A, Cole P. Injury. Treatment of distal femur fractures with the DePuy-Synthes variable angle locking compression plate. Spontaneous osteonecrosis of the knee (SONK). government site. He offers Online Physiotherapy Appointments. Fowles JV, Kassab MT. official website and that any information you provide is encrypted Epub 2011 May 4. Eur Radiol. Cartilage replacement surgeries commonly depend upon the size of the defect and the quality of the remaining cartilage edge. Ehlinger M., Ducrot G., Adam P., Bonnomet F. Distal femur fractures. Ergin N, Demirel M, entrk F, Bayram S, Bilgili F. Long-term comparative study of internal fixation with Kirschner wires or cannulated screws for displaced medial epicondyle fractures of the humerus in children: A 10-year follow-up of 42 cases. [QxMD MEDLINE Link]. Strength in the leg will also need to be regained as this will have also reduced with the inactivity. 8600 Rockville Pike Treatment and Rehabilitation of Fractures. Depasquale R, Fotiadou A, Kumar DS, Lalam R, Tins B, Tyrrell PN, Singh J, Cassar-Pullicino VN. [37, 38] and open fracture are indications for operative management. At 2 years postoperatively, the patient underwent a cavovarus foot reconstruction; however, patient continued to suffer from ankle pain (VAS 6) and ultimately underwent below knee amputation at 3 years . The entity subsumes that previously known as spontaneous osteonecrosis of the knee (SONK/SPONK) or Ahlbck disease. Clipboard, Search History, and several other advanced features are temporarily unavailable. It occurs more frequently in females, and the medial femoral condyle is the most common location, due to a more limited intraosseous blood supply, with watershed areas, as opposed to the lateral femoral condyle. Glotzbecker M. Distal humeral physeal, medial condyle, lateral epicondylar, and other uncommon elbow fractures. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture. Firth AM, Marson BA, Hunter JB. 1). More profound ulnar nerve dysfunction has been observed to occur with manipulative reduction attempts, especially if closed manipulation of an incarcerated fragment is attempted. The most "classic" location for OCD lesions of the knee is the lateral aspect of the medial femoral condyle of the distal femur. The major controversy involving medial epicondyle fractures has involved the management of displaced fractures. The plate was fixed provisionally and lag screw fixation was done with two cannulated cancellous screws. National Library of Medicine Joint distention techniques also have been described to help facilitate closed reduction of the incarcerated medial epicondyle fracture. Surgery can consist initially of cleaning up the rough edges and seeing how the patient does. North Am. (2019) AJR. For bicondylar fractures, a median parapatellar incision can be used. Femoral Condyle | Articular Cartilage Injury | Minneapolis, St. Paul Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. Then, we placed the proximal tibia plate (Depuy Synthes: LCP proximal tibial plate 4.5) upside down (Fig. [QxMD MEDLINE Link]. 2010;29: 38-42. sharing sensitive information, make sure youre on a federal Knee Fracture Management in the Emergency Department - Medscape J Oral Maxillofac Surg. 2010 Oct;48(7):520-6. doi: 10.1016/j.bjoms.2009.10.010. A smaller defect with good cartilage shoulders can potentially be treated with a microfracture. All you need to do is just give us a call on 0410 559 856 and request an initial appointment. Epub 2012 Aug 2. The https:// ensures that you are connecting to the Imaging of early stages of osteonecrosis of the knee. An official website of the United States government. Schematic of two types of medial condyle fractures, as described by Milch. high energy with significant displacement, low energy, often fall from standing, in osteoporotic bone, usually with lesser degree of displacement, medial condyle extends more distal than lateral, posterior halves of both condyles are posterior to the posterior cortex of femoral shaft, direction of deformity is dependent on the location of comminution and the relation of fracture lines to the adductor tubercle, extension at the fracture site (apex posterior), rotation of condyles when an intercondylar split is present, portion of the articular surface remains in continuity with shaft, 33B3 is in the coronal plane (Hoffa fragment), articular fragment separated from the shaft, pain of distal femur that is made worse with knee movement, knee effusion may be present with intraarticular involvement, evaluate for wounds concerning for an open fracture, <0.9 = 97% specific and 95% sensitive for major arterial injury, AP, lateral, and oblique traction views can help characterize injury but are painful for the patient, obtain imaging of entire femur to rule out associated injuries, consider views of the contralateral femur for pre-operative planning and templating, can be difficult to visualize intraarticular extension, condyles are malrotated in sagittal plane with respects to each other, sagittal intra-articular splut is most common, intra-articular distal femoral fracture in the coronal plane, after external fixation to assess pattern, comminution, and intraarticular extension, separate osteochondral fragments in the area of the intercondylar notch, i.e., hard and soft signs (pulselessness, rapidly expanding hematoma, massive bleeding, etc.