Locking Plate Alone or in Combination with Cannulated Screws for Hoffa Fractures: A Retrospective Study. Issue 3 (30th January 2022)

• Record Type: Journal Article
• Authors: Li, Zhen; Chen, Zhenyue; Wang, Xiaotan; Li, Jingyin; Jing, Lizhong; Li, Zehui; Cao, Xuewei
• Is Part Of: Orthopaedic surgery. Volume 14:Issue 3(2022)
• Page Start: 492
• Page End: 500
• Publication Date: 2022-01-30
• Subjects: Hoffa fractures -- locking plate -- cannulated screws -- early rehabilitation; Orthopedic surgery -- Periodicals; Orthopedics -- Periodicals; Musculoskeletal system -- Wounds and injuries -- Periodicals; 617.47005
• DOI: 10.1111/os.13201
• Languages: English
• ISSNs: 1757-7853

Abstract

Abstract: Objective: To determine the efficacy of distal femur condyle locking plate (DFCLP) alone or in combination with cannulated screws for Hoffa fractures. Methods: In this study, between May 2014 and February 2019, 13 patients between 26 and 64 years with isolated Hoffa fractures were enrolled during the study period and retrospectively analyzed. All patients underwent open reduction and internal fixation by DFCLP alone or in combination with cannulated screws followed by early active rehabilitation postoperatively. The primary outcome was evaluated using range of movement (ROM), Knee Society Score (KSS), International Knee Documentation Committee (IKDC) scoring system, and the fracture healing time of the patients during the 24‐month follow‐up period. Postoperative complications were also used to assess the patients' conditions. Results: A total of 13 patients completed the 24‐month follow‐up assessment and achieved bone re‐union at Hoffa fracture sites. The average follow‐up period was 24.5 months (ranging from 24 to 28 months). Six patients were treated by DFCLP in combination with cannulated screws and the remaining seven patients were treated by DFCLP alone. The mean ROM was determined as 119° (ranging from 100° to 130°). The mean KSS score was 87.9 (ranging from 80 to 92 points), with 11 patients evaluated as excellent, two as good, and zero bad cases. The mean IKDC score was 84.2 (ranging from 74.7 to 89.7 points), with 10 evaluated as excellent, three as good, and zero bad cases. The mean IKDC score was 83.3 for patients with medial Hoffa fractures and 84.4 for those with lateral Hoffa fractures. The average time to healing was 3.5 months (ranging from 3 to 4 months), and at month 3, the fracture healing was evident in seven patients (54%), and at month 4, fracture healing was seen in six patients (46%). It is worth mentioning that two patients suffered from knee joint stiffness and osteoarthritis during the 24 months follow‐up. Eleven patients (84.6%) achieved satisfactory knee joint function through early postoperative rehabilitation. Conclusion: In patients with Hoffa fractures, treatment with DFCLP alone or in combination with cannulated screws followed by early active rehabilitation resulted in great stability and satisfactory functional outcomes after 24 months. Our findings may provide surgeons with a new way to treat Hoffa fractures. Abstract : (Left) A 60‐year‐old female patient suffered from Hoffa fracture due to a high‐velocity fall. CT of left knee showed a type Letenneur III medial Hoffa fracture (A, B). Radiographs showed that the patient underwent open reduction and internal fixation, and a DFCLP and four cannulated screws were placed at the medial distal femoral condyle (C, D). The patient could acquire nearly 0°‐130° range of motion after 24 months postoperatively with a good functional recovery (E, F). (Upper right) A 52‐year‐old male patient sustained a left Hoffa fracture in a motor vehicle accident. Lateral radiograph and CT of left knee showed a type Letenneur III lateral Hoffa fracture (A–C). Radiographs showed that the patient underwent open reduction and internal fixation, and a DFCLP alone was placed at the lateral distal femoral condyle (D, E). Twenty‐four months after the operation, nearly 0°–120° range of motion was obtained in the patient with satisfactory functional results (F, G). (Lower right) Schematic illustration of anatomic locking plate on distal femur lateral condyle (A) and medial condyle (B). Ten fix screw holes are evenly distributed on the condyle, which could better fix the fracture fragments. Eight of them are arranged in arc along the boundary and could fix the joint surface effectively.