Trikha Vivek, Das Saubhik, Gaba Sahil, Agrawal Prabhat
JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
J Orthop Surg (Hong Kong). 2017 May-Aug;25(2):2309499017718928. doi: 10.1177/2309499017718928.
Hoffa fractures are uncommon intra-articular fractures of femoral condyle in coronal plane. The purpose of our study is to assess radiologic and functional outcome in operatively treated Hoffa fractures.
We retrospectively reviewed 32 patients of isolated Hoffa fracture from January 2010 to March 2015. All were treated with open reduction and internal fixation using lateral approach for lateral Hoffa and medial approach for medial Hoffa fracture. Cancellous screws in lag mode and/or antiglide plate were employed for fixation in accordance with fracture anatomy. All patients were subjected to aggressive physical therapy postoperatively. Knee Society Score (KSS), International Knee Documentation Committee Score (IKDC), and Knee range of motion (ROM) were documented at final follow-up for functional evaluation.
All fractures united by mean time of 11.56 ± 1.5 weeks. No evidence of subsequent displacement or fixation failure, arthritis, Avascular necrosis (AVN) of femoral condyle was elicited in any of the patients. Documented mean KSS and mean IKDC Score at final follow-up were 83.19 ± 8.43 and 81.62± 6.95, respectively. ROM at final follow-up was ranging from 0° to mean 116.41° ± 13.98°. Complications included stiffness of the involved knee in four patients, including one patient who developed infection and had to undergo implant removal after fracture union.
Operative treatment of Hoffa fractures yields fairly good functional outcome. One must endeavor to achieve adequate intraoperative exposure and stable congruous articular reconstruction. Early aggressive physical therapy is a harbinger of optimal outcome.
Hoffa骨折是股骨髁在冠状面的少见关节内骨折。本研究的目的是评估手术治疗Hoffa骨折的影像学和功能结果。
我们回顾性分析了2010年1月至2015年3月间32例孤立性Hoffa骨折患者。所有患者均接受切开复位内固定治疗，外侧Hoffa骨折采用外侧入路，内侧Hoffa骨折采用内侧入路。根据骨折解剖结构，采用拉力螺钉和/或防滑钢板进行固定。所有患者术后均接受积极的物理治疗。在末次随访时记录膝关节协会评分（KSS）、国际膝关节文献委员会评分（IKDC）和膝关节活动范围（ROM），以进行功能评估。
所有骨折平均在11.56±1.5周愈合。所有患者均未出现随后的移位、内固定失败、关节炎、股骨髁缺血性坏死（AVN）。末次随访时记录的平均KSS和平均IKDC评分分别为83.19±8.43和81.62±6.95。末次随访时ROM范围为0°至平均116.41°±13.98°。并发症包括4例患侧膝关节僵硬，其中1例患者发生感染，骨折愈合后不得不取出内固定物。
手术治疗Hoffa骨折可获得较好的功能结果。必须努力在术中获得充分暴露并进行稳定的关节面重建。早期积极的物理治疗是获得最佳结果的预兆。
