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📌Osteochondral Fractures and Impaction Fractures
✅ Definition and Characteristics
- An osteochondral fracture occurs when a curvilinear fracture completely encircles a portion of the subchondral bone and the overlying cartilage, resulting in an osteochondral fragment.
- This type of injury typically occurs in the setting of acute trauma.
✅ Impaction Fractures: Subchondral Bone Depression
- An osteochondral fracture is characterized by subchondral bone depression or fragmentation, leading to the creation of an osteochondral fragment.
- This can be visualized on imaging as a hypointense fracture line and subchondral bone plate depression.
- Impaction fractures represent a specific type of osteochondral fracture.
- For instance, a deep lateral femoral sulcus may occur after an anterior cruciate ligament (ACL) tear.
- These fractures show a spectrum of histologic findings from bone marrow edema-like signal intensity to microfractures of the subcortical trabeculae.
Lateral Femoral Condyle and ACL Tears
- Secondary findings often include osseous injuries involving the anterior aspect of the lateral femoral condyle and the posterior aspect of the lateral tibial plateau in the case of ACL ruptures.
- These injuries, resulting from the impaction of the lateral femoral condyle against the posterolateral tibial plateau during internal rotation and anterior translation of the tibia, may present as bone contusions or subchondral trabecular fractures.
✅ Imaging and Diagnosis
Key imaging signs of osteochondral injuries to the lateral femoral condyle include:
- Deep Notch Sign: Abnormal deepening of the condylofemoral sulcus larger than 1.5 mm (or 2 mm).
- Long Notch Sign: Abnormal lengthening of the condylofemoral sulcus.
References
- J Clin Orthop Trauma. 2021 Sep 25;22:101610.
- RadioGraphics 2018; 38:1478–1495.
- AJR 2019; 213:963–982.
- Magn Reson Imaging Clin N Am 30 (2022) 261–275.
- World J Orthop 2011 August 18; 2(8): 75-84.
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#OsteochondralFracture, #ImpactionFracture, #SubchondralBone, #ACLInjury, #LateralFemoralCondyle, #BoneContusion, #Radiology, #Orthopedics, #MRI, #TraumaInjury
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