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.	李兴华, 刘亚波. Hoffa 骨折的治疗. 中华创伤骨科杂志, 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.	周亚斌, 王庆贤, 陈伟. Hoffa 骨折的研究进展. 中华外科杂志, 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.	刘兆杰, 贾健, 胡永成, 等. 胫骨后外侧平台骨折手术入路及内固定方式的研究进展. 中华创伤杂志, 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, Poyanlı 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, Çolak İ, et al. Surgically treated Hoffa fractures with poor long-term functional results. Injury, 2018, 49(2): 398-403.
14.	马献忠, 米豫飞, 常守亚. 后路空心加压螺钉结合抗滑动钢板内固定治疗 Letenneur Ⅰ型 Hoffa 骨折. 中华创伤骨科杂志, 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.	时宏富, 蔡贤华, 汪国栋, 等. 股骨髁冠状面骨折的分型与治疗. 中华创伤骨科杂志, 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.	李卫华, 刘亚波, 王满宜. 抗滑动钢板治疗 Letenneur Ⅰ型 Hoffa 骨折的生物力学研究. 中华创伤骨科杂志, 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.	连霄, 曾云记. 经后外侧入路采用 meta 钢板联合空心钉内固定治疗 Letenneur Ⅲ型外侧 Hoffa 骨折. 中国骨伤, 2018, 31(3): 267-271.
26.	张云彬, 魏景梅, 孙晓太. 骨伤科医源性腓总神经损伤常见原因及预防. 中国误诊学杂志, 2005, 5(9): 1765-1766.
27.	刘洪文, 徐杰, 林院, 等. 腓总神经 “预松解” 预防重度膝外翻畸形人工全膝节置术后神经麻痹. 中华医学杂志, 2020, 100(7): 516-520.
28.	王海, 谢昀, 林章雄, 等. 扩大 Carlson 切口钢板内固定治疗胫骨后外侧平台合并前外侧平台骨折. 中华创伤杂志, 2020, 36(10): 905-911.
29.	姚俊娜, 王洪刚, 权松涛, 等. 后侧腘窝 S 形切口双窗口入路治疗胫骨平台后柱骨折. 中国修复重建外科杂志, 2020, 34(5): 574-578.
30.	李成, 周其佳, 孙月柏, 等. 腓骨小头部分切除联合腓肠肌外侧头切断入路治疗胫骨平台后外侧髁骨折. 中国骨与关节损伤杂志, 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. 李兴华, 刘亚波. Hoffa 骨折的治疗. 中华创伤骨科杂志, 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. 周亚斌, 王庆贤, 陈伟. Hoffa 骨折的研究进展. 中华外科杂志, 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. 刘兆杰, 贾健, 胡永成, 等. 胫骨后外侧平台骨折手术入路及内固定方式的研究进展. 中华创伤杂志, 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, Poyanlı 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, Çolak İ, et al. Surgically treated Hoffa fractures with poor long-term functional results. Injury, 2018, 49(2): 398-403.
14. 马献忠, 米豫飞, 常守亚. 后路空心加压螺钉结合抗滑动钢板内固定治疗 Letenneur Ⅰ型 Hoffa 骨折. 中华创伤骨科杂志, 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. 时宏富, 蔡贤华, 汪国栋, 等. 股骨髁冠状面骨折的分型与治疗. 中华创伤骨科杂志, 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. 李卫华, 刘亚波, 王满宜. 抗滑动钢板治疗 Letenneur Ⅰ型 Hoffa 骨折的生物力学研究. 中华创伤骨科杂志, 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. 连霄, 曾云记. 经后外侧入路采用 meta 钢板联合空心钉内固定治疗 Letenneur Ⅲ型外侧 Hoffa 骨折. 中国骨伤, 2018, 31(3): 267-271.
26. 张云彬, 魏景梅, 孙晓太. 骨伤科医源性腓总神经损伤常见原因及预防. 中国误诊学杂志, 2005, 5(9): 1765-1766.
27. 刘洪文, 徐杰, 林院, 等. 腓总神经 “预松解” 预防重度膝外翻畸形人工全膝节置术后神经麻痹. 中华医学杂志, 2020, 100(7): 516-520.
28. 王海, 谢昀, 林章雄, 等. 扩大 Carlson 切口钢板内固定治疗胫骨后外侧平台合并前外侧平台骨折. 中华创伤杂志, 2020, 36(10): 905-911.
29. 姚俊娜, 王洪刚, 权松涛, 等. 后侧腘窝 S 形切口双窗口入路治疗胫骨平台后柱骨折. 中国修复重建外科杂志, 2020, 34(5): 574-578.
30. 李成, 周其佳, 孙月柏, 等. 腓骨小头部分切除联合腓肠肌外侧头切断入路治疗胫骨平台后外侧髁骨折. 中国骨与关节损伤杂志, 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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