Kurahatti Ajay, Seenappa Hariprasad, Shanthappa Arun H, S Nagakumar J
Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND.
Cureus. 2022 Apr 4;14(4):e23829. doi: 10.7759/cureus.23829. eCollection 2022 Apr.
Distal femur AO type 33 B fractures consist of partial articular fractures subdivided into three types namely sagittal lateral condyle fracture, medial condyle fracture, and coronal split fracture. Coronal plane fractures of the distal femur are less frequent compared to sagittal plane fractures and are known as Hoffa fractures. The mechanism of injury is usually a direct anteroposterior force to the flexed and abducted knee for lateral condylar fractures and a direct impact on the medial side of the knee in flexion for a medial condylar fracture. Various approaches like lateral parapatellar for lateral condylar Hoffa's fixation, with or without posterior approach for open reduction of Hoffa's fracture with screw or buttress plate fixation, medial parapatellar approach for medial condylar Hoffa's fracture screw fixation are used.
This study was conducted at R L Jalappa Hospital and Research Center attached to Sri Devaraj Urs Medical College, Kolar, India, from June 2017 to May 2020 with 17 patients as a sample size.
Seventeen patients with Hoffa's fracture were treated with cannulated cancellous screws with lag effect including 12 males and five females with a mean age of 31.1 years. The range of motion ranged from 120 to 135 degrees of flexion with a mean of 125.2 degrees. Three patients had extensor lag ranging from 5 to 10 degrees with an average of 6.3 degrees. Neer scores were excellent in 11, good in four, and fair in two patients. The average fracture union time for the lateral condyle was 16.4 months and for the medial condyle, it was 16.7 months.
Restoration of articular anatomy and its congruence is of paramount importance for better surgical outcomes. Closed or open reduction and stable fixation with anteroposterior cannulated cancellous screws are essential. A good post-operative rehabilitation program is required for better outcomes.
股骨远端AO 33 B型骨折为部分关节骨折，分为三种类型，即矢状面外侧髁骨折、内侧髁骨折和冠状面劈裂骨折。与矢状面骨折相比，股骨远端冠状面骨折较少见，被称为霍法骨折。外侧髁骨折的损伤机制通常是对屈曲外展膝关节的直接前后向暴力，而内侧髁骨折是对屈曲膝关节内侧的直接撞击。采用了各种手术入路，如用于外侧髁霍法骨折固定的外侧髌旁入路，有或无后路用于切开复位并采用螺钉或支撑钢板固定霍法骨折，用于内侧髁霍法骨折螺钉固定的内侧髌旁入路。
本研究于2017年6月至2020年5月在印度科拉尔市斯里德瓦拉杰乌尔医学院附属的RL贾拉帕医院及研究中心进行，样本量为17例患者。
17例霍法骨折患者采用具有拉力作用的空心松质骨螺钉治疗，其中男性12例，女性5例，平均年龄31.1岁。活动范围为屈曲120至135度，平均为125.°2度。3例患者存在伸肌滞后，范围为5至10度，平均为6.3度。11例患者的Neer评分优秀，4例良好，2例一般。外侧髁骨折的平均愈合时间为16.4个月，内侧髁骨折为16.7个月。
恢复关节解剖结构及其一致性对于获得更好的手术效果至关重要。闭合或切开复位以及使用前后向空心松质骨螺钉进行稳定固定是必不可少的。为获得更好的效果，需要良好的术后康复计划。
