Novel approach of plate assisted buttressing in Hoffa fracture
Amit Singh1, Nirottam Singh2, Gaurav Siwach1
1Department of Orthopaedics, Dr. S.N. Medical College, Jodhpur, Rajasthan, India.
Insights
Surgical fixation of Hoffa fractures using cancellous screws and a posterior buttress plate offers effective treatment. This method provides adequate stability and reliable outcomes for femoral condyle fractures.
Area of Science:
- Orthopaedic Surgery
- Traumatology
Background:
- Hoffa fractures, involving the femoral condyle in the coronal plane, are often difficult to diagnose and conservative management leads to complications.
- Displaced Hoffa fractures necessitate surgical intervention due to the inadequacy of standard cancellous screw fixation against vertical shear stress.
Purpose of the Study:
- To evaluate the clinical outcomes of open reduction and internal fixation for Letenneur type I Hoffa fractures.
- To assess the efficacy of using cancellous screws combined with a posterior buttressing plate.
Main Methods:
- A prospective cohort study included 36 patients with Letenneur type I Hoffa fractures.
- Patients underwent open reduction and internal fixation with cancellous screws and a posterior buttress plate.
- Clinical outcomes, range of motion (ROM), bone union, and Knee Society Score (KSS) were assessed at 4 and 12 months.
Main Results:
- The study included 36 patients (22 males, 14 females) aged 25-54, with injuries from road traffic accidents or falls.
- Significant improvements were observed in ROM (120.4° at 4 months, 128.1° at 12 months) and KSS (85.0 at 4 months, 89.3 at 12 months).
- All fractures achieved union within an average of 3.2 months, with statistically significant improvements noted by the 12-month follow-up.
Conclusions:
- Fixation of Letenneur type I Hoffa fractures with cancellous screws and a posterior buttress plate is effective and reliable.
- This technique provides adequate stability for Hoffa fractures.
- Posterior buttress plate augmentation enhances conventional lag screw fixation for Hoffa fractures.
Purpose:
Hoffa fracture is a femoral condyle fracture in the coronal plane. The lateral condyle is more commonly involved. The diagnosis is often difficult to detect with routine radiographs. Conservative management in this type of fracture resulted in nonunion, malunion, and other complications, such as stiff knee. Therefore, surgical management is mandatory in displaced fractures. Previous studies suggest only application of cancellous screw fixation, but these are not enough to counter vertical shear stress. Therefore, this study will evaluate the clinical outcomes of open reduction and internal fixation of Letenneur type I Hoffa fracture using cancellous screws with posterior buttressing plate.
Method:
This was a prospective cohort study conducted from March 2017 to July 2022 in orthopaedics department of tertiary care center after approval of institutional ethical committee. The study included 36 patients with Letenneur type I fractures treated by open reduction and internal fixation using posterior buttress plate and cancellous screws. Radiographs and clinical outcomes, range of movement (ROM), bone union, and knee society score (KSS) of patients were assessed at the end of 4 and 12 months in the follow-ups. All statistical analysis was done using Epi info version 7.2.1.0.
Results:
In the 36 patients with Letenneur type I fracture, the majority belong to younger age group between 25 and 54 years with 22 males and 14 females. The modes of injury were road traffic accidents in 25 patients and fall from height in 11 patients. The right knee was involved in 21 cases and left was involved in 15 cases. Lateral condyle involvement was seen in 27 cases and medial condyle in 9 cases. All 36 patients with Letenneur type I Hoffa fracture were evaluated 4 months after surgical intervention. The notable improvements were observed in terms of ROM 120.4° ± 5.0° and KSS 85.0 ± 4.2. At the 12-month follow-up, considerably better outcomes were maintained regarding ROM 128.1° ± 5.2° and KSS 89.3 ± 4.8 with p < 0.05 which was statistically significant. At the final follow-up, all patients had routine fracture healing with a union time of (3.2 ± 3.4) months.
Conclusions:
Fixation of Letenneur type I Hoffa fracture with cancellous screws and posterior buttress plate is effective, reliable and capable of providing adequate stability. Buttress plate assisted fixation is a valuable enhancement of the conventional technique of lag screw fixation of Hoffa fractures.
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