The patient was a 25-year-old man who was currently enrolled in a military basic-training program.

He was evaluated by a physical thera-pist in a direct-access capacity for a chief complaint of right knee pain and swell-ing after his knee buckled and gave way during a training exercise on an obstacle course. He was unable to continue with the training exercise following his right knee injury.

The patient was evaluated by the physical therapist 2 days after his injury. Visual observation revealed significant right knee effusion and an inability to bear weight on the right lower extremity

or flex his knee beyond 80°. Distal puls-es and sensation were intact. Meniscal and ligamentous examination was lim-ited and inconclusive due to significant guarding and effusion.

Because the patient was unable to bear weight on his right lower extremity or flex his right knee to 90°, the physi-cal therapist ordered radiographs of the right knee,2 which demonstrated a frac-ture of the lateral femoral condyle pos-teriorly (FIGURE 1).1 The physical therapist immediately referred the patient to an orthopaedic surgeon, and the fracture was further evaluated with computed tomography (FIGURE 2).1 The patient was

[ musculoskeletal imaging ]

SCOTT D. CAROW, DPT, DSc, OCS, SCS, Department of Physical Therapy, Martin Army Community Hospital, Fort Benning, GA.STEVEN M. POTTER, MD, Department of Orthopaedic Surgery, Martin Army Community Hospital, Fort Benning, GA.

Fracture of the Lateral Femoral Condyle

subsequently managed with open reduc-tion internal fixation of the lateral femo-ral condyle. Furthermore, intraoperative evaluation of the knee revealed no other significant injuries of the soft tissues and articular cartilage that required surgi-cal intervention. At 6 months following surgery, after participation in an exten-sive rehabilitation program, there was radiographic evidence of fracture heal-ing (FIGURE 3, available at www.jospt.org), and the patient was allowed to return to unrestricted military service. t J Or-thop Sports Phys Ther 2013;43(12):933. doi:10.2519/jospt.2013.0421

FIGURE 1. Lateral radiograph of the right knee demonstrating a fracture of the lateral femo-ral condyle posteriorly (arrow), as well as surrounding soft tissue swelling and a large joint effusion.

FIGURE 2. 3-D computed tomography scan (sagittal view) of the right knee demonstrating a fracture of the lateral femoral condyle posteriorly (Hoffa fracture) (arrow).

journal of orthopaedic & sports physical therapy | volume 43 | number 12 | december 2013 | 933

References 1. Arastu MH, Kokke MC, Duffy PJ, Korley RE, Buckley RE. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. Bone Joint J.

2013;95-B:1165-1171. http://dx.doi.org/10.1302/0301-620X.95B9.30656 2. Bachmann LM, Haberzeth S, Steurer J, ter Riet G. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med. 2004;140:121-124.

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