Zhou Y B, Wang Q X, Chen W
Emergence Center of Trauma, Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, Orthopedic Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, China.
Zhonghua Wai Ke Za Zhi. 2017 Jan 1;55(1):73-77. doi: 10.3760/cma.j.issn.0529-5815.2017.01.019.
Hoffa fracture is a rare type of fracture confined to the coronal plane of the femoral condyle. High-energy is a common reason of Hoffa fracture, and low-energy trauma and iatrogenic injury can also cause Hoffa fracture in some cases. The commonly used classifications include Letenneur classification, CT classification, AO classification and modified AO classification. X-ray is the first choice to diagnose Hoffa fractures, fracture lines can be found. If the X-ray is negative, CT scan and MRI should be performed. Nondisplaced fractures can be managed conservatively with cast immobilization, however, there is high risk of redisplacement. Open reduction and internal fixation is preferred. For the young patient with good compliance, a simple medial or lateral condylar fractures can be treated via medial or lateral parapatellar approach. When the fracture is exposed, the headless compression screws can be inserted vertical to the fracture line from backward to forward. For a bicondylar fracture, median parapatellar incision can be selected. While for a complex fracture with osteoporosis or high body mass index, cannulated screws with anti-sliding plate fixation technique should be used.
Hoffa骨折是一种局限于股骨髁冠状面的罕见骨折类型。高能损伤是Hoffa骨折的常见原因,在某些情况下,低能量创伤和医源性损伤也可导致Hoffa骨折。常用的分类方法包括Letenneur分类、CT分类、AO分类和改良AO分类。X线是诊断Hoffa骨折的首选方法,可发现骨折线。若X线检查结果为阴性,则应进行CT扫描和MRI检查。无移位骨折可采用石膏固定进行保守治疗,但存在较高的再移位风险。首选切开复位内固定。对于依从性好的年轻患者,单纯的内侧或外侧髁骨折可通过内侧或外侧髌旁入路进行治疗。暴露骨折后,可从后向前垂直于骨折线插入无头加压螺钉。对于双髁骨折,可选择正中髌旁切口。而对于合并骨质疏松或体重指数较高的复杂骨折,应采用带防滑钢板固定技术的空心螺钉。