How to determine the surgical approach in Hoffa fractures?

Orapiriyakul, Wich; Apivatthakakul, Theerachai; Buranaphatthana, Thanawat

doi:10.1016/j.injury.2018.11.034

Cited by 22 publications

(23 citation statements)

References 35 publications

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“…Undisplaced Hoffa fractures are often missed and when neglected, can lead to non-union. An antero-medial incision is preferred in order to adequately expose the fracture fragment [6,7]. A non-operative intervention leads to the risk of avascular necrosis, arthritis with articular incongruity, and non-union [5,8].…”

Section: Discussionmentioning

confidence: 99%

Non-Union of Isolated Medial Condyle of Femur Hoffa Fracture: Case Report

Manjeswar¹,

Kale²,

Raithatha³

et al. 2023

Cureus

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Isolated non-united Hoffa fracture of the femur is a rare finding. They are often missed due to the nature of the fracture and when not assessed appropriately. This is a case report of a 40-year-old male who encountered a high-velocity trauma; the fracture was probably missed on plain radiographs following the trauma. The patient presented to us eight months following the trauma with complaints of pain and decreased range of motion of his right knee (10 to 80 degrees of flexion) and the patient was unable to bear weight on the affected limb. On evaluation, the patient was found to have a non-united Hoffa fracture involving the medial condyle. The patient was treated with freshening of fracture followed by rigid fixation with cancellous screws and reconstruction plate. Postoperatively by week six, the patient achieved full range of motion and was able to walk without assistance with evidence of union on plain radiographs.

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Section: Discussionmentioning

confidence: 99%

Non-Union of Isolated Medial Condyle of Femur Hoffa Fracture: Case Report

Manjeswar¹,

Kale²,

Raithatha³

et al. 2023

Cureus

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“…There is no optimal surgical approach and fixation method for Hoffa fractures as described in Table 1 . Direct lateral/medial and posterolateral approaches can expose small Hoffa fragments and employ the more biologically advantageous posterior-anterior direction screws, as well as a plate if necessary, but with a risk of neurovascular injury; lateral/medial parapatellar approaches are suitable for large Hoffa fragments and can expose both the femoral condyles, but small Hoffa fragments are difficult to expose and reduce, and posterior-anterior direction screws are not feasible[ 17 ]. Other studies[ 18 - 21 ] reported the treatment of the nonunion of Hoffa fracture, suggesting bone grafting following debridement and fixation with screws and bone plates, and finally achieved satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

Hoffa’s fracture in an adolescent treated with an innovative surgical procedure: A case report

Jiang¹,

Wang²,

Ye³

et al. 2022

WJCC

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BACKGROUND Hoffa fracture is rare, especially in adolescents, and has a high rate of complications such as avascular necrosis and osteoarthritis; moreover, there are no definitive guidelines for its treatment. This report could provide a new potential treatment for Hoffa fracture. CASE SUMMARY A 16-year-old girl presented to the orthopedic emergency department of No. 2 People’s Hospital of Yibin City with persistent pain following a right knee injury sustained during a sprint race. Her knee was swollen and tender, and the range of motion was restricted by the pain. X-ray and computed tomography revealed a Hoffa fracture in the right knee. After consultation, surgical treatment was performed, and the fracture was fixed with three 3.5-mm cannulated cancellous screws; osteochondral plugs that were harvested from the screw insertion site were re-implanted to cover the screw head. The patient’s fracture and osteochondral plug healed 6 mo postoperatively, and she presented a knee range of motion of 0–135 without pain, and was walking without support with a normal gait. CONCLUSION Here, we describe an innovative surgical procedure for Hoffa fracture that could provide a new possibility for the treatment of similar fractures, and further improve their management.

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“…However, it is difficult to insert a P-A screw perpendicularly to a Hoffa fracture using a direct lateral approach. Therefore, an additional posterior approach is necessary [22], which inevitably increases the risk of common peroneal nerve injury or a compromise in blood supply [23]. In addition, fixation using a P-A screw necessitates advancing screws through the posterior condylar cartilage area, which will damage the weight-bearing articular surface [23].…”

Section: Discussionmentioning

confidence: 99%

“…The surgical approach also determines the screw trajectory. Given that the Hoffa fracture is diagnosed in association with 38.1% of supracondylar-intercondylar femoral fractures [4], a direct lateral approach (DLA) or parapatellar approach (PPA) is typically chosen to treat the associated fractures simultaneously [22,23]. A-P screws and crossed screws can be smoothly utilized through the use of these approaches.…”

Section: Introductionmentioning

confidence: 99%

A biomechanical comparison of two screw fixation methods in a Letenneur type I Hoffa fracture

Yao

Hsu

et al. 2020

BMC Musculoskelet Disord

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Background: The treatment of Hoffa fractures is challenging, for which the ideal fixation and approach are still controversial. Osteosynthesis with plate or screws fixation in different trajectories have been described in previous literature. The purpose of this study was to compare the biomechanical strength and stability of two types of screw trajectories used to stabilize displaced coronal fractures of the lateral femoral condyle. Methods: Sixteen synthetic femurs (Sawbones Pacific Research Laboratories, Vashon, WA) were divided into two groups. A vertical osteotomy was performed to mimic a Letenneur type I Hoffa fracture. Group A (n = 8) was fixed with screw in anteroposterior direction (A-P) screws. Group B (n = 8) was fixed with crossed screws. Both groups were tested with a nondestructive axial compression aligned with the femur axis. After that, 10,000 cyclic loading tests were applied to the specimen with a force ranging between 200 to 600 N, and the interfragmental displacement was recorded, respectively, after 10, 100, 1000 and 10,000 cycles. Finally, a destructive axial compression test was applied until catastrophic failure. Results: There were no statistical between-group differences in regard to the average axial stiffness, interfragmental displacement, and ultimate failure load. The average axial stiffness of the A-P screw was comparable to that of the crossed screw (361 ± 113 N/mm vs. 379 ± 65 N/mm, p = 0.753). All specimens completed the entire cyclic loading test without catastrophic failure, and the interfragmental displacement after loading for 10,000 cycles was 1.36 ± 0.40 mm for the A-P screw and 1.29 ± 0.61 mm for the crossed screw, there were no statistical differences between the groups (p = 0.823). The average ultimate failure loads for the A-P and crossed screws were 1214 ± 127 N and 1109 ± 156 N, respectively (p = 0.172). Conclusions: Based on our in vitro study, the crossed screws can provide comparable mechanical performance as traditional A-P screws in Hoffa fracture fixation. Considering the screws trajectories are commonly determined by the choice of surgical approach, the current study provides support from a biomechanical perspective for the application of crossed screws in direct lateral approach.

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How to determine the surgical approach in Hoffa fractures?

Cited by 22 publications

References 35 publications

Non-Union of Isolated Medial Condyle of Femur Hoffa Fracture: Case Report

Non-Union of Isolated Medial Condyle of Femur Hoffa Fracture: Case Report

Hoffa’s fracture in an adolescent treated with an innovative surgical procedure: A case report

A biomechanical comparison of two screw fixation methods in a Letenneur type I Hoffa fracture

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