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Jia P, Chang X, Tang X. Two types of cannulated screw fixation based on Letenneur classification for the treatment of Hoffa fracture: A finite element analysis. J Orthop Sci 2025:S0949-2658(24)00271-9. [PMID: 39755478 DOI: 10.1016/j.jos.2024.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 10/31/2024] [Accepted: 11/30/2024] [Indexed: 01/06/2025]
Abstract
PURPOSE A finite element analysis was performed to simulate the biomechanical differences between anterior-posterior (AP) direction and posterior-anterior (PA) direction placement of two cannulated screws in Hoffa fractures. METHODS Computed tomography images of an healthy male volunteer were used to simulate Letenneur Ⅰ, Ⅱa, Ⅱb, Ⅱc, Ⅲ Hoffa fractures, and two groups of screw internal fixation models were constructed. Two 6.5 mm cannulated screws were implanted parallel in the AP direction or the PA direction. The biomechanical test was performed to determine the displacement, stress distribution, and peaks in the distal femur and cannulated screws in 10 models. RESULTS The displacement distribution and peak values of the distal femur and cannulated screws in both groups were similar, and displacement increasing as the load increased. The stress distribution in the distal femur was similar between the two groups, with stress mainly concentrated on both sides of the fracture line, the posterolateral and anterior aspects of the femoral shaft. The peak stress in the PA group of the Letenneur type Ⅱb was significantly higher than that in the AP group, and the stress in the distal femur increased with increasing load. The stress distribution in the cannulated screws of Letenneur Ⅰ, Ⅱa, Ⅱb, and Ⅲ, was similar, but differences are observed between the two groups in type Ⅱc. The stress in the cannulated screws increased with increasing load, and the peak values in the PA group are significantly higher than those in the AP group. CONCLUSION The mechanical stability of the two screw insertion methods is similar. Inserting screws from anterior to posterior can reduce the stress on the distal femur and cannulated screws, and also minimize the dissection of the posterior soft tissues. Therefore, inserting screws from anterior to posterior is a more recommended surgical approach for Hoffa fractures.
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Affiliation(s)
- Peng Jia
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China; Department of Orthopaedic Trauma, Shandong Second Provincial General Hospital, Jinan, Shandong 250023, China.
| | - Xiaohu Chang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.
| | - Xin Tang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.
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Liu J, Lu Z, Zheng Z. The effect of screw orientation on internal fixation of Letenneur type II Hoffa fractures: a biomechanics study. BMC Musculoskelet Disord 2024; 25:107. [PMID: 38308240 PMCID: PMC10835960 DOI: 10.1186/s12891-024-07222-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/22/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND To investigate the biomechanical effects of screw orientation and fracture block size on the internal fixation system for Letenneur type II Hoffa fractures. METHODS The fracture models were randomly divided into six groups according to the fracture subtypes and the direction of nail placement, and a plumb line of the posterior condylar tangent was made across the base of the posterior femoral condyle. The fracture blocks of the three types of fracture were calculated and recorded in the sagittal position, and the biomechanical performance of the six groups was evaluated by biomechanical tests. The axial load on the fracture block at a displacement of 2 mm was set as the failure load, a gradually increasing axial load was applied to each fracture model using a customized indenter at a load of 250-750 N, and the displacements and failure loads of the six groups were recorded at different axial loads. RESULTS Biomechanical test results showed that the larger the fracture block, the greater was the stability when nailing from front to back, and the smaller the fracture block, the greater was the strength when nailing from back to front (p < 0.001). As the fracture block became larger, the biomechanical advantage of nailing from posterior to anterior decreased.The displacement under 250 N load were 1.351 ± 0.113 mm, 1.465 ± 0.073 mm for Group IIa AP and Group IIa PA. The displacement under 500 N load were 2.596 ± 0.125 mm, 2.344 ± 0.099 mm for Group IIa AP and Group IIa PA. The displacement under 750 N load were 3.997 ± 0.164, 3.386 ± 0.125 mm for Group IIa AP and Group IIa PA. The failure loads were 384 ± 14 N, 415 ± 19 N for Group IIa AP and Group IIa PA. In the type IIa fracture group, the difference was no longer significant (p > 0.001). Therefore, there is a mechanical threshold that ranges from 38.36 to 52.33% between type IIa and type IIb fractures. CONCLUSIONS The effect of the nailing direction on the strength of fixation has a fracture-block critical point, which is consistent overall with the trend that the larger the fracture block is, the greater the stability when nailing from anterior to posterior, and the smaller the fracture block is, the greater the strength when nailing from posterior to anterior.
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Affiliation(s)
- Jialun Liu
- Department of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhe Lu
- Department of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhanle Zheng
- Department of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
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Rabelo JMG, Pires RE, de Las Casas EB, Cimini Jr CA. Busch-Hoffa fracture: A systematic review. Medicine (Baltimore) 2023; 102:e36161. [PMID: 38050206 PMCID: PMC10695599 DOI: 10.1097/md.0000000000036161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/26/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Accomplish a thorough review on the existing biomechanical and clinical studies about coronal plane fractures of the distal femur. METHODS We performed an electronic search of PubMed/MEDLINE database from April to June, 2023. The terms for the database search included "Hoffa fractures," OR "Busch-Hoffa fractures" OR "coronal plane fractures of the distal femur." RESULTS The search identified 277 potentially eligible studies. After application of inclusion and exclusion criteria, 113 articles were analyzed in terms of the most important topics related to coronal plane fractures of the distal femur. CONCLUSION Lateral coronal plane fractures of the distal femur are more frequent than medial, present a more vertical fracture line, and usually concentrate on the weight bearing zone of the condyle. The Letenneur system is the most used classification method for this fracture pattern. Posterior-to-anterior fixation using isolated lag screws (for osteochondral fragments-Letenneur type 2) or associated with a posterior buttressing plate (when the fracture pattern is amenable for plate fixation-Letenneur types 1 and 3) is biomechanically more efficient than anterior-to-posterior fixation. Anterior-to-posterior fixation using lag screws complemented or not by a plate remains a widely used treatment option due to the surgeons' familiarity with the anterior approaches and lower risk of iatrogenic neurovascular injuries. There is no consensus in the literature regarding diameter and number of screws for fixation of coronal plane fractures of the distal femur.
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Affiliation(s)
- João Marcos Guimarães Rabelo
- Federal University of Minas Gerais, Federal Center for Technological Education of Minas Gerais (CEFET-MG), Belo Horizonte, Brazil
| | - Robinson Esteves Pires
- Department of the Locomotor Apparatus (Orthopaedic Trauma Service), Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Jiao Y, Suo Y, Chen J, Yan R, Yuan Z, Shi Y, Chang C, Wei M. Application of the suture anchor in the treatment of Hoffa fractures of the lateral femoral condyle. J Orthop Surg Res 2023; 18:512. [PMID: 37464389 DOI: 10.1186/s13018-023-04005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND To evaluate the feasibility and clinical effect of the suture anchor combined with external fixation in the treatment of the lateral femoral condyle Hoffa fracture. METHODS In this study, a retrospective study was conducted to analyze the feasibility of treating fourteen patients (eight men and six women) with Hoffa fractures admitted to our Hospital from January 2016 to October 2021 with combined external fixation using incisional reduction anchor nailing. The age of the patients ranged from 23 to 45 years, with an average of 37.5 years. According to Letenneur's classification, there were eight cases of type I, three cases of type II, and three cases of type III. The functional assessment of Letenneur was used to measure the clinical outcome. RESULTS All patients had one-stage wound healing, and all patients were followed up for 12 to 18 months after surgery, and all fractures healed well, with normal knee flexion and extension activities, and no complications such as fracture displacement, anchor nail loosening, or fracture malunion were observed. The clinical outcome was evaluated according to the functional evaluation criteria of Letenneur et al. The clinical outcome of fourteen patients: excellent in thirteen cases and good in one case, with an overall excellent rate of 100%. CONCLUSIONS Our study results indicate that the use of anchor nailing combined with external fixation for Hoffa fractures of the femoral condyle has some clinical reference significance because it is less invasive, has fewer complications, does not require secondary removal, and is worthy of clinical application. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Yingya Jiao
- Department of Sports Injury and Arthroscopy, Handan City Central Hospital, Hebei, 056001, Handan, China
| | - Yanhui Suo
- Department of Sports Injury and Arthroscopy, Handan City Central Hospital, Hebei, 056001, Handan, China
| | - Junlin Chen
- Department of Sports Injury and Arthroscopy, Handan City Central Hospital, Hebei, 056001, Handan, China
| | - Ruihai Yan
- Department of Sports Injury and Arthroscopy, Handan City Central Hospital, Hebei, 056001, Handan, China
| | - Zhongqiang Yuan
- Department of CT Room, Handan City Central Hospital, Hebei Handan, 056001, China.
| | - Yinhu Shi
- Department of CT Room, Handan City Central Hospital, Hebei Handan, 056001, China
| | - Cheng Chang
- Department of CT Room, Handan City Central Hospital, Hebei Handan, 056001, China
| | - Meng Wei
- Department of CT Room, Handan City Central Hospital, Hebei Handan, 056001, China
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Muacevic A, Adler JR, Raithatha H, Shah S. Non-Union of Isolated Medial Condyle of Femur Hoffa Fracture: Case Report. Cureus 2023; 15:e34187. [PMID: 36843777 PMCID: PMC9951551 DOI: 10.7759/cureus.34187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
Isolated non-united Hoffa fracture of the femur is a rare finding. They are often missed due to the nature of the fracture and when not assessed appropriately. This is a case report of a 40-year-old male who encountered a high-velocity trauma; the fracture was probably missed on plain radiographs following the trauma. The patient presented to us eight months following the trauma with complaints of pain and decreased range of motion of his right knee (10 to 80 degrees of flexion) and the patient was unable to bear weight on the affected limb. On evaluation, the patient was found to have a non-united Hoffa fracture involving the medial condyle. The patient was treated with freshening of fracture followed by rigid fixation with cancellous screws and reconstruction plate. Postoperatively by week six, the patient achieved full range of motion and was able to walk without assistance with evidence of union on plain radiographs.
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Affiliation(s)
- Alexander Muacevic
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - John R Adler
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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Suo YH, Chen JL, Li QS, Chen X, Xie YP, Gu PF, Li XN, Li YS. Treatment of Hoffa fracture of femoral condyle with anchor combined with auxiliary fixation. J Back Musculoskelet Rehabil 2023; 36:1185-1192. [PMID: 37458023 DOI: 10.3233/bmr-220378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND A Hoffa fracture is an unstable intra-articular break that is generally treated with surgery. OBJECTIVE To evaluate the feasibility and clinical outcomes of using a suture anchor combined with auxiliary fixation for the treatment of a lateral femoral condyle Hoffa fracture. METHODS The study retrospectively reviewed 8 patients (5 males and 3 females) with a lateral femoral condyle Hoffa fracture who had been treated by combining a suture anchor with auxiliary fixation between January 2016 and April 2020. The mean age of patients was 37.5 years (ranging from 23 to 45). According to Letenneur's classification, there were 4 cases of type I, 2 cases of type II, and 2 cases of type III fractures. The clinical outcomes were assessed using Letenneur's functional assessment. RESULTS The follow-up duration ranged between 14-24 months. All patients achieved primary healing of the incision and fracture union, as well as normal flexion and extension of the knee joint, with 7 cases showing excellent outcomes and 1 case showing a good outcome. No postoperative complications, such as fracture displacement, anchor loosening, or fracture malunion, occurred in this series. CONCLUSION Our results indicated that a suture anchor, combined with external fixation, was an effective treatment for a lateral femoral condyle Hoffa fracture. Accordingly, this procedure is worthy of wider clinical application.
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Valgus knee deformity due to nonunion of lateral Hoffa fracture: A case report. Trauma Case Rep 2022; 40:100662. [PMID: 35637866 PMCID: PMC9144006 DOI: 10.1016/j.tcr.2022.100662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/23/2022] Open
Abstract
Hoffa fractures are rare intra-articular injuries, and nonunion of Hoffa fractures is rarer. We report the case of an adult male with a nonunion of a Hoffa fracture by open reduction and internal fixation in which the lateral meniscus tear was treated by an arthroscopic surgery. A healthy 38-year-old man who had a history of untreated trauma to the left knee in a motorcycle accident 11 years ago presented to our hospital with the complaint of chronic left knee pain for 5 years. The patient had an obvious valgus knee with 0°–140° of motion, and radiographs revealed the nonunion of the left lateral Hoffa fracture (Letenneur type-III). Routine arthroscopic evaluation and a lateral meniscus posterior tear repair using all inside device were performed. The knee joint was exposed using a lateral para patella approach. The fracture was fixed with three 4.5-mm headless screws and distal femoral locking plates. Mobilization was started from the first operative day. Full weight bearing was allowed 8 weeks postoperatively. At the 1-year follow up, the X-ray showed healing of the nonunion site with no displacement of the Hoffa fracture. The knee range of motion, lower limb alignment, and clinical outcome were also improved. Nonunion of the Hoffa fracture should be treated by an internal fixation despite the chronicity.
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Jiang ZX, Wang P, Ye SX, Xie XP, Wang CX, Wang Y. Hoffa’s fracture in an adolescent treated with an innovative surgical procedure: A case report. World J Clin Cases 2022; 10:1410-1416. [PMID: 35211577 PMCID: PMC8855179 DOI: 10.12998/wjcc.v10.i4.1410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/10/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hoffa fracture is rare, especially in adolescents, and has a high rate of complications such as avascular necrosis and osteoarthritis; moreover, there are no definitive guidelines for its treatment. This report could provide a new potential treatment for Hoffa fracture.
CASE SUMMARY A 16-year-old girl presented to the orthopedic emergency department of No. 2 People’s Hospital of Yibin City with persistent pain following a right knee injury sustained during a sprint race. Her knee was swollen and tender, and the range of motion was restricted by the pain. X-ray and computed tomography revealed a Hoffa fracture in the right knee. After consultation, surgical treatment was performed, and the fracture was fixed with three 3.5-mm cannulated cancellous screws; osteochondral plugs that were harvested from the screw insertion site were re-implanted to cover the screw head. The patient’s fracture and osteochondral plug healed 6 mo postoperatively, and she presented a knee range of motion of 0–135 without pain, and was walking without support with a normal gait.
CONCLUSION Here, we describe an innovative surgical procedure for Hoffa fracture that could provide a new possibility for the treatment of similar fractures, and further improve their management.
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Affiliation(s)
- Zu-Xin Jiang
- Department of Orthopaedics, No. 2 People’s Hospital of Yibin City, Yibin 644000, Sichuan Province, China
| | - Pan Wang
- Department of Orthopaedics, No. 2 People’s Hospital of Yibin City, Yibin 644000, Sichuan Province, China
| | - Shun-Xin Ye
- Department of Orthopaedics, No. 2 People’s Hospital of Yibin City, Yibin 644000, Sichuan Province, China
| | - Xiao-Ping Xie
- Department of Orthopaedics, No. 2 People’s Hospital of Yibin City, Yibin 644000, Sichuan Province, China
| | - Chun-Xiu Wang
- Department of Oncology, No. 2 People’s Hospital of Yibin City, Yibin 644000, Sichuan Province, China
| | - Yue Wang
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu 640000, Sichuan Province, China
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