Tetsunaga Tomonori, Sato Toru, Shiota Naofumi, Yoshida Masahiro, Mochizuki Yusuke, Tetsunaga Tomoko, Teramoto Arubi, Okazaki Yoshiki, Yamada Kazuki
Department of Orthopaedic Surgery, Okayama Medical Center, 1711-1 Tamasu, Kitaku, Okayama, 701-1192, Japan,
J Orthop Sci. 2013 Sep;18(5):798-802. doi: 10.1007/s00776-013-0410-5. Epub 2013 Jun 4.
Many difficulties are associated with treating fractures of the posterior condyle of the femur (Hoffa fractures). Anatomical reduction and internal fixation are optimum for such intra-articular fractures. Some surgeons use anteroposterior screws to achieve direct stability. However, screw fixation is not adequate in some cases. To increase stability, we treat Hoffa fractures with a posterior buttress plate; we use a twisted, 1/3 tubular plate at the posterior surface and a supplementary, locking compression plate (LCP) for additional stability.
Patients who had sustained Hoffa fractures between January 2006 and March 2009 were included in this study. Patients comprised three males and two females with a mean age of 73.6 years at the time of surgery. A 3.5-mm 1/3 tubular plate was twisted and applied to the posterolateral aspect of the distal femur. This was combined with an LCP on the distal femur to achieve a rafting effect.
All fractures were healed within 15 weeks. There were no instances of nonunion, infection, or implant removal. The mean range of motion was -3° to 121°. Four patients had no pain in the treated limb and one had mild pain on weight bearing. The average Oxford Knee Score was 44.6 points. All patients achieved satisfactory joint function and regained their walking ability with good clinical results.
Improved stability associated with this technique enables patients to begin range-of-motion training and return to their normal activities sooner; this resulted in good outcome.
股骨后髁骨折（霍法骨折）的治疗存在诸多困难。对于此类关节内骨折，解剖复位和内固定是最佳治疗方法。一些外科医生使用前后位螺钉来实现直接稳定性。然而，在某些情况下，螺钉固定并不充分。为提高稳定性，我们采用后支撑钢板治疗霍法骨折；我们在股骨后表面使用一个扭曲的1/3管状钢板，并使用一块辅助锁定加压钢板（LCP）以增强稳定性。
本研究纳入了2006年1月至2009年3月期间发生霍法骨折的患者。患者包括3名男性和2名女性，手术时平均年龄为73.6岁。将一块3.5毫米的1/3管状钢板扭曲后应用于股骨远端的后外侧。将其与股骨远端的LCP联合使用以实现筏式固定效果。
所有骨折均在15周内愈合。没有出现骨不连、感染或植入物取出的情况。平均活动范围为-3°至121°。4名患者治疗的肢体无疼痛，1名患者负重时有轻微疼痛。牛津膝关节平均评分为44.6分。所有患者均获得了满意的关节功能，恢复了行走能力，临床效果良好。
该技术提高的稳定性使患者能够更早开始活动范围训练并恢复正常活动；结果良好。
