Effectiveness of extended Carlson approach in treatment of lateral femoral condylar Hoffa fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Hai , YE Junjian , ZHENG Lifeng , CHEN Yaoqing , WU Gui ,  XIE Yun

Department of Orthopedic Trauma & Ankle Surgery, Fujian Trauma Medical Center, First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350004, P.R.China;

Corresponding?author：

XIE Yun, Email: xyxlr@126.com

Keywords：

Hoffa fracture; lateral femoral condylar; surgical approach; internal fixation

DOI：

10.7507/1002-1892.202009025

Video：

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Objective To investigate the effectiveness of the extended Carlson approach in the treatment of lateral femoral condylar Hoffa fractures.Methods The clinical data of 17 patients with lateral femoral condyle Hoffa fractures between September 2012 and January 2019 were retrospectively analyzed. There were 10 males and 7 females, with a mean age of 43 years (range, 32-68 years). Fractures were caused by traffic accident in 9 cases, by falling from height in 6 cases, and by the other mechanism in 2 cases. According to the Letenneur’s classification, there were 8 cases of typeⅠ, 6 cases of type Ⅱ, and 3 cases of type Ⅲ. The mean time from injury to operation was 7 days (range, 3-32 days). All patients were treated with extended Carlson approach. Patients with Letenneur types Ⅰ and Ⅲ were fixed by a posterior antigliding plate combined with headless compression screws from anteroposterior direction, and patients with Letenneur typeⅡ were fixed by headless compression screws from anteroposterior direction. The anteroposterior and lateral X-ray films, CT and three-dimensional reconstruction of the knee joint were taken after operation to assess fracture healing and position of the internal fixators. The knee function was evaluated according to Letenneur’s functional assessment system.Results All patients were followed up 13-28 months (mean, 15 months). All the incisions healed by first intention, and no complication such as fracture redisplacement, fracture nonunion, internal fixator fracture, and common peroneal nerve injury occurred. The mean time of fracture healing was 18 weeks (range, 16-32 weeks). At last follow-up, according to Letenneur’s functional assessment system, the knee function was excellent in 12 cases and good in 5 cases, with an excellent and good rate of 100%.Conclusion The extended Carlson approach for the treatment of lateral femoral condylar Hoffa fractures has the advantages of clear exposure, easy reduction and fixation, high fracture healing rate, few complications, and good recovery of knee joint function.

Citation： WANG Hai, YE Junjian, ZHENG Lifeng, CHEN Yaoqing, WU Gui, XIE Yun. Effectiveness of extended Carlson approach in treatment of lateral femoral condylar Hoffa fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(4): 439-444. doi: 10.7507/1002-1892.202009025 Copy

1.	Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fractures—a prospective review of 18 patients. Injury, 2011, 42(12): 1495-1498.
2.	Hoffa A. The first treatment for bone fractures and dislocations. From the series on “First Medical Treatment” occasioned by the Central Committee for Medical Education in Prussia (Winter Semester 1904-05). Z Arztl Fortbild Qualitatssich, 2001, 95(3): 229-230.
3.	Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. Acta Orthop Traumatol Turc, 2014, 48(4): 383-387.
4.	李興華, 劉亞波. Hoffa 骨折的治療. 中華創傷骨科雜志, 2011, 13(7): 620-625.
5.	Min L, Tu CQ, Wang GL, et al. Internal fixation with headless compression screws and back buttress plate for treatment of old Hoffa fracture. Chin J Traumatol, 2014, 17(2): 79-83.
6.	Lee SY, Niikura T, Iwakura T, et al. Bicondylar hoffa fracture successfully treated with headless compression screws. Case Rep Orthop, 2014: 139897.
7.	周亞斌, 王慶賢, 陳偉. Hoffa 骨折的研究進展. 中華外科雜志, 2017, 55(1): 73-77.
8.	Tripathy SK, Aggarwal A, Patel S, et al. Neglected Hoffa fracture in a child. J Pediatr Orthop B, 2013, 22(4): 339-343.
9.	Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma, 2005, 19(2): 73-78.
10.	劉兆杰, 賈健, 胡永成, 等. 脛骨后外側平臺骨折手術入路及內固定方式的研究進展. 中華創傷雜志, 2019, 35(4): 368-376.
11.	Letenneur J, Labour PE, Rogez JM, et al. Hoffa’s fractures. Report of 20 cases (author’s transl). Ann Chir, 1978, 32(3-4): 213-219.
12.	Akan K, Akgün U, Poyanl? O, et al. Arthroscopy-assisted treatment of Hoffa fracture associated with ipsilateral femoral shaft, tibial eminence and Malgaigne fractures. Acta Orthop Traumatol Turc, 2014, 48(5): 602-606.
13.	Onay T, Gülabi D, ?olak ?, et al. Surgically treated Hoffa fractures with poor long-term functional results. Injury, 2018, 49(2): 398-403.
14.	馬獻忠, 米豫飛, 常守亞. 后路空心加壓螺釘結合抗滑動鋼板內固定治療 Letenneur Ⅰ型 Hoffa 骨折. 中華創傷骨科雜志, 2011, 13(7): 686-687.
15.	Dhillon MS, Mootha AK, Bali K, et al. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. Musculoskelet Surg, 2012, 96(1): 49-54.
16.	Sasidharan B, Shetty S, Philip S, et al. Reconstructive osteotomy for a malunited medial Hoffa fracture-A feasible salvage option. J Orthop, 2016, 13(3): 132-135.
17.	Xu Y, Li H, Yang HH, et al. A comparison of the clinical effect of two fixation methods on Hoffa fractures. Springerplus, 2016, 5(1): 1164. doi: 10.1186/s40064-016-2861-6.
18.	Zhou Y, Pan Y, Wang Q, et al. Hoffa fracture of the femoral condyle: Injury mechanism, classification, diagnosis, and treatment. Medicine (Baltimore), 2019, 98(8): e14633. doi: 10.1097/MD.0000000000014633.
19.	Jarit GJ, Kummer FJ, Gibber MJ, et al. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). J Orthop Trauma, 2006, 20(4): 273-276.
20.	時宏富, 蔡賢華, 汪國棟, 等. 股骨髁冠狀面骨折的分型與治療. 中華創傷骨科雜志, 2007, 9(2): 118-121.
21.	Liebergall M, Wilber JH, Mosheiff R, et al. Gerdy’s tubercle osteotomy for the treatment of coronal fractures of the lateral femoral condyle. J Orthop Trauma, 2000, 14(3): 214-215.
22.	Lu B, Zhao S, Luo Z, et al. Compression screws and buttress plate versus compression screws only for Hoffa fracture in Chinese patients: a comparative study. J Int Med Res, 2019, 47(1): 142-151.
23.	李衛華, 劉亞波, 王滿宜. 抗滑動鋼板治療 Letenneur Ⅰ型 Hoffa 骨折的生物力學研究. 中華創傷骨科雜志, 2009, 11(9): 850-853.
24.	Cheng PL, Choi SH, Hsu YC. Hoffa fracture: should precautions be taken during fixation and rehabilitation? Hong Kong Med J, 2009, 15(5): 385-387.
25.	連霄, 曾云記. 經后外側入路采用 meta 鋼板聯合空心釘內固定治療 Letenneur Ⅲ型外側 Hoffa 骨折. 中國骨傷, 2018, 31(3): 267-271.
26.	張云彬, 魏景梅, 孫曉太. 骨傷科醫源性腓總神經損傷常見原因及預防. 中國誤診學雜志, 2005, 5(9): 1765-1766.
27.	劉洪文, 徐杰, 林院, 等. 腓總神經 “預松解” 預防重度膝外翻畸形人工全膝節置術后神經麻痹. 中華醫學雜志, 2020, 100(7): 516-520.
28.	王海, 謝昀, 林章雄, 等. 擴大 Carlson 切口鋼板內固定治療脛骨后外側平臺合并前外側平臺骨折. 中華創傷雜志, 2020, 36(10): 905-911.
29.	姚俊娜, 王洪剛, 權松濤, 等. 后側腘窩 S 形切口雙窗口入路治療脛骨平臺后柱骨折. 中國修復重建外科雜志, 2020, 34(5): 574-578.
30.	李成, 周其佳, 孫月柏, 等. 腓骨小頭部分切除聯合腓腸肌外側頭切斷入路治療脛骨平臺后外側髁骨折. 中國骨與關節損傷雜志, 2015, 30(6): 650-651.

1. Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fractures—a prospective review of 18 patients. Injury, 2011, 42(12): 1495-1498.
2. Hoffa A. The first treatment for bone fractures and dislocations. From the series on “First Medical Treatment” occasioned by the Central Committee for Medical Education in Prussia (Winter Semester 1904-05). Z Arztl Fortbild Qualitatssich, 2001, 95(3): 229-230.
3. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. Acta Orthop Traumatol Turc, 2014, 48(4): 383-387.
4. 李興華, 劉亞波. Hoffa 骨折的治療. 中華創傷骨科雜志, 2011, 13(7): 620-625.
5. Min L, Tu CQ, Wang GL, et al. Internal fixation with headless compression screws and back buttress plate for treatment of old Hoffa fracture. Chin J Traumatol, 2014, 17(2): 79-83.
6. Lee SY, Niikura T, Iwakura T, et al. Bicondylar hoffa fracture successfully treated with headless compression screws. Case Rep Orthop, 2014: 139897.
7. 周亞斌, 王慶賢, 陳偉. Hoffa 骨折的研究進展. 中華外科雜志, 2017, 55(1): 73-77.
8. Tripathy SK, Aggarwal A, Patel S, et al. Neglected Hoffa fracture in a child. J Pediatr Orthop B, 2013, 22(4): 339-343.
9. Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma, 2005, 19(2): 73-78.
10. 劉兆杰, 賈健, 胡永成, 等. 脛骨后外側平臺骨折手術入路及內固定方式的研究進展. 中華創傷雜志, 2019, 35(4): 368-376.
11. Letenneur J, Labour PE, Rogez JM, et al. Hoffa’s fractures. Report of 20 cases (author’s transl). Ann Chir, 1978, 32(3-4): 213-219.
12. Akan K, Akgün U, Poyanl? O, et al. Arthroscopy-assisted treatment of Hoffa fracture associated with ipsilateral femoral shaft, tibial eminence and Malgaigne fractures. Acta Orthop Traumatol Turc, 2014, 48(5): 602-606.
13. Onay T, Gülabi D, ?olak ?, et al. Surgically treated Hoffa fractures with poor long-term functional results. Injury, 2018, 49(2): 398-403.
14. 馬獻忠, 米豫飛, 常守亞. 后路空心加壓螺釘結合抗滑動鋼板內固定治療 Letenneur Ⅰ型 Hoffa 骨折. 中華創傷骨科雜志, 2011, 13(7): 686-687.
15. Dhillon MS, Mootha AK, Bali K, et al. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. Musculoskelet Surg, 2012, 96(1): 49-54.
16. Sasidharan B, Shetty S, Philip S, et al. Reconstructive osteotomy for a malunited medial Hoffa fracture-A feasible salvage option. J Orthop, 2016, 13(3): 132-135.
17. Xu Y, Li H, Yang HH, et al. A comparison of the clinical effect of two fixation methods on Hoffa fractures. Springerplus, 2016, 5(1): 1164. doi: 10.1186/s40064-016-2861-6.
18. Zhou Y, Pan Y, Wang Q, et al. Hoffa fracture of the femoral condyle: Injury mechanism, classification, diagnosis, and treatment. Medicine (Baltimore), 2019, 98(8): e14633. doi: 10.1097/MD.0000000000014633.
19. Jarit GJ, Kummer FJ, Gibber MJ, et al. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). J Orthop Trauma, 2006, 20(4): 273-276.
20. 時宏富, 蔡賢華, 汪國棟, 等. 股骨髁冠狀面骨折的分型與治療. 中華創傷骨科雜志, 2007, 9(2): 118-121.
21. Liebergall M, Wilber JH, Mosheiff R, et al. Gerdy’s tubercle osteotomy for the treatment of coronal fractures of the lateral femoral condyle. J Orthop Trauma, 2000, 14(3): 214-215.
22. Lu B, Zhao S, Luo Z, et al. Compression screws and buttress plate versus compression screws only for Hoffa fracture in Chinese patients: a comparative study. J Int Med Res, 2019, 47(1): 142-151.
23. 李衛華, 劉亞波, 王滿宜. 抗滑動鋼板治療 Letenneur Ⅰ型 Hoffa 骨折的生物力學研究. 中華創傷骨科雜志, 2009, 11(9): 850-853.
24. Cheng PL, Choi SH, Hsu YC. Hoffa fracture: should precautions be taken during fixation and rehabilitation? Hong Kong Med J, 2009, 15(5): 385-387.
25. 連霄, 曾云記. 經后外側入路采用 meta 鋼板聯合空心釘內固定治療 Letenneur Ⅲ型外側 Hoffa 骨折. 中國骨傷, 2018, 31(3): 267-271.
26. 張云彬, 魏景梅, 孫曉太. 骨傷科醫源性腓總神經損傷常見原因及預防. 中國誤診學雜志, 2005, 5(9): 1765-1766.
27. 劉洪文, 徐杰, 林院, 等. 腓總神經 “預松解” 預防重度膝外翻畸形人工全膝節置術后神經麻痹. 中華醫學雜志, 2020, 100(7): 516-520.
28. 王海, 謝昀, 林章雄, 等. 擴大 Carlson 切口鋼板內固定治療脛骨后外側平臺合并前外側平臺骨折. 中華創傷雜志, 2020, 36(10): 905-911.
29. 姚俊娜, 王洪剛, 權松濤, 等. 后側腘窩 S 形切口雙窗口入路治療脛骨平臺后柱骨折. 中國修復重建外科雜志, 2020, 34(5): 574-578.
30. 李成, 周其佳, 孫月柏, 等. 腓骨小頭部分切除聯合腓腸肌外側頭切斷入路治療脛骨平臺后外側髁骨折. 中國骨與關節損傷雜志, 2015, 30(6): 650-651.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of extended Carlson approach in treatment of lateral femoral condylar Hoffa fractures

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