Relationships between Hoffa fragment size and surgical approach selection: a cadaveric study

Orapiriyakul, Wich; Apivatthakakul, Theerachai; Phornphutkul, Chanakarn

doi:10.1007/s00402-018-3022-x

Cited by 14 publications

(15 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…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]. Alternatively, Xu et al treated eleven Hoffa fracture patients using crossed screws, and a comparison with traditional screws showed no significant differences in the function outcomes after 2 years of follow-up, which might indicate that crossed screws are as effective as traditional screws [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…For fixation of a Hoffa fracture, an A-P screw is easier to apply via the parapatellar approach. However, an anatomic study showed that when the Hoffa fragment is less than 10.1% of the AP diameter of the lateral condyle, the parapatellar approach does not allow direct visualization of the fracture [23], which makes reduction difficult and may result in unsatisfactory results. In contrast, the direct lateral approach may provide better access to the Hoffa fracture.…”

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%

See 3 more Smart Citations

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

Yao

Hsu

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Yao

Hsu

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Screw fixation is the standard method for treating Hoffa fracture, but continuous improvement is seen in the internal fixation method for these fractures 10 . At least 2 screws should be used to give biomechanical stability to the fracture, and the screws should cross the fracture line perpendicular to the fracture line to achieve compression of fracture fragments 11,12 . The screws can be inserted in either anterior to the posterior direction or posterior to the anterior direction 15 .…”

mentioning

confidence: 99%

Untitled

2022

IJPSR

View full text Add to dashboard Cite

Background: Hoffa fracture management is almost always surgical since it involves the intraarticular part of the femur. It can be managed either with cannulated cancellous screw alone or with the addition of a buttress plate. The study aimed to evaluate and compare the functional outcome of fracture fixation between the CC screw &CC screw with a buttress plate. Method: This was a prospective study of 30 patients with Hoffa fracture conducted between January 2020 to December 2021. Patients were allotted into 2 groups. Group A was treated with CC screw fixation, Group B was treated with CC screw + buttress plate. Post-operatively, follow-up was done for 1 year. Results: There were 14 males and 16 females in our study with both sides equally injured. The mean age of patients was 36.1 ranging from 23 to 52 years. RTA was the most common mode of injury. The average blood loss during group A was 117 ml and for group, B was 182.1 ml which is statistically significant. The average postoperative LKSS score after 3 months was 76.1 for group A and 88.1 for group B which is statistically significant. Conclusion: Hoffa fracture treated with CC screws alone had less blood loss and hospital stay but not significantly better than CC screw with a buttress plate in terms of knee ROM and functional score. Both procedures didn't have significant complications. INTRODUCTION:The Hoffa fracture of the distal femur is a coronal fracture involving one or both of the femoral condyles 1 . These fractures are quite rare and so can be picked up only with a high index of suspicion. Lateral condylar and bilateral condylar fractures are more common than medial condylar fractures 2 . As per the AO/OTA classification, Hoffa fractures come under type 33-B3 3 .

show abstract

Operative Zugänge am Kniegelenk: Distales Femur

Peez,

Berninger

2024

Orthopädie Und Unfallchirurgie

View full text Add to dashboard Cite

Relationships between Hoffa fragment size and surgical approach selection: a cadaveric study

Cited by 14 publications

References 28 publications

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

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

Untitled

Operative Zugänge am Kniegelenk: Distales Femur

Contact Info

Product

Resources

About