Cannulated lag screws for Hoffa fracture: evaluation for functional recovery

doi:10.3969/j.issn.2095-4344.2014.17.013

Abstract

Abstract:

BACKGROUND: Hoffa fracture belongs to intraarticular fracture, and is rare in the clinic. It is difficult to be diagnosed in clinic and radiographs. Missed diagnosis easily occurs, so it is hard to be cured. Improper therapy would induce disunion of fracture or knee dysfunction.
OBJECTIVE: To observe the clinical efficacy of Hoffa fracture treated with cannulated lag screws.
METHODS: From May 2007 to April 2012, seven patients with Hoffa fracture were treated with cannulated lag screws, including 5 males and 2 females, aged from 23 to 57 years old, averagely 37 years old. They accepted the X-ray, CT and MRI examinations of anteroposterior and lateral knee joints. After surgery, facture healing, the incidence of complications and recovery of limb function were observed during follow-up.
RESULTS AND CONCLUSION: All patients were followed up for 18-36 months, averagely 24 months. Fractures were healed. Complications did not occur such as loosing fixation and fracture re-displacement. The range of motion of knee joint was greater than 110°. According to the knee Letenneur assessment criteria, there were excellent in six cases and good in one case. According to the U.S. Hospital for Special Surgery knee score, the efficacy was excellent. Results suggested that cannulated lag screws for Hoffa fracture were characterized by stable fixation, few complications, early functional exercises and good efficacy.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: intra-articular fractures, fracture fixation, internal, internal fixators, range of motion, articular

CLC Number:

R318

Chen Tie-zhu, Wang Yi-sheng . Cannulated lag screws for Hoffa fracture: evaluation for functional recovery[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(17): 2697-2702.

Figures/Tables 2

2.4 并发症无内固定松动断裂及骨折移位、骨折不愈合、骨折块坏死等并发症发生。 2.5 典型病例患者男，29岁，2012年3月23日修房子时不慎从高处坠落，立即出现左膝关节肿痛，不能站立行走，立即在桑植县中医院行MRI提示左膝半月板损伤，左膝后交叉韧带损伤，予以左下肢石膏固定，消肿止痛等处理，患者转入湖南省人民医院要求手术治疗，入院时体格检查右膝关节肿胀，压痛，浮髌试验(+)，后方抽屉试验(+)，lachman征(+)，麦氏征(+)，患者因疼痛拒绝进一步检查，关节腔穿刺抽出血性液体70 mL，可见脂滴，肢端血运感觉正常。入院后行X射线检查：左股骨内侧髁骨质改变，骨折？左侧腓骨头骨折(图1A，B)，建议进一步CT检查；行CT检查：左股骨内髁粉碎性骨折，左胫骨平台骨折，左腓骨上段骨折(图1C-F)。于2012年4月9日连硬外麻下行左膝关节镜检查+左股骨内侧髁骨折开放复位内固定，关节镜下见左股骨内髁骨折并移位，左膝后交叉韧带稍松弛，连续性存在，外侧半月板损伤，予以关节镜下成形半月板，转为骨折开放复位内固定，行左膝关节内侧髌旁入路，屈膝90°，将髌骨推向外侧，显露骨折端，见骨折为斜行骨折，股骨髁软骨面台阶形成，清理骨折残端，复位骨折块，检查股骨髁软骨面平整，避免台阶形成，2枚克氏针临时固定，空心拉力螺钉由前向后固定骨折端，螺钉尽量与骨折线垂直，螺钉钉尾位于关节软骨面外。该患者腓骨头骨折移位不明显，腓总神经无损伤，未进行特殊处理。术后复查X射线片：左股骨内髁骨折内固定未见明显松动(图1G，H)。术后予以膝关节可调节活动支架固定，指导膝关节功能锻炼，膝关节功能活动良好，术后19个月取出内固定，复查X射线片：左股骨髁未见骨折线，无内固定存留(图1I，J)。膝关节功能恢复良好。"

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