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Relationships between Hoffa fragment size and surgical approach selection: a cadaveric study
Wich Orapiriyakul1, Theerachai Apivatthakakul2,3, Chanakarn Phornphutkul1,4
1Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Archives of Orthopaedic and Trauma Surgery
|August 13, 2018
Summary
This study provides guidelines for selecting surgical approaches for Hoffa fractures. The medial parapatellar approach (MPPA) and lateral parapatellar approach (LPPA) are suitable for larger fragments, while the direct medial approach (DMA) or posterolateral approach (PLA) are recommended for smaller ones.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Anatomy
Background:
- Fixation of small Hoffa fragments necessitates careful surgical approach selection.
- Current guidelines for choosing the optimal approach for small posterior Hoffa fractures are lacking.
Purpose of the Study:
- To compare fragment sizes treatable with the medial parapatellar approach (MPPA) versus the direct medial approach (DMA).
- To compare fragment sizes treatable with the lateral parapatellar approach (LPPA) versus the posterolateral approach (PLA).
Main Methods:
- Cadaveric dissection of medial and lateral condyles using MPPA, DMA, LPPA, and PLA.
- Measurement of anterior-posterior (AP) diameter and specific boundary distances to determine fragment size relative to condyle dimensions.
Main Results:
- Medial condyle: d1/d3 (MPPA vs. DMA boundary) was 18.3%, d2/d3 (DMA boundary) was 28.7%.
- Lateral condyle: d1/d3 (LPPA vs. PLA boundary) was 10.1%, d2/d3 (PLA boundary) was 19.9%.
Conclusions:
- Parapatellar approaches (PPA) are indicated for fragments >18.3% (medial) or >10.1% (lateral) of AP diameter.
- DMA or PLA with posterior-to-anterior screws are recommended for fragments <28.7% (medial) or <19.9% (lateral).
- Combined approaches may be necessary for complex cases with articular comminution.
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