Absorbable screws and anatomical plate of medial femoral condyle for treatment of medial condyle Hoffa fractures: good steel plate attachment and firm fixation

doi:10.3969/j.issn.2095-4344.2015.09.015

Abstract

Abstract:

BACKGROUND: Medial condyle Hoffa fractures is often accompanied by joint surface grinding, so improper therapy would induce disunion of fracture or knee dysfunction. Screw fixation alone is difficult to realize entirety of comminuted fracture block. Fixation intensity is poor. In addition, common steel plate for medial condyle Hoffa fractures requires constant shaping during surgery. Moreover, it limits the direction of the screw and impacts the stability of fracture fragments after resetting.
OBJECTIVE: To explore the characteristics of medial condyle Hoffa fractures, and analyze the effects of absorbable screws combined with femoral condyle anatomical plate in the treatment of above fracture.
METHODS: Data of 12 patients with medial condyle Hoffa fractures treated with absorbable screws combined with distal medial femoral anatomic plates in the Department of Traumatic Orthopedics of Tianjin Hospital in China from May 2010 to June 2013 were retrospectively analyzed. There were 8 males and 4 females at the age of 21-67 years, averagely 42 years. Before treatment, all patients were subjected to knee anterioposterior, lateral X-ray films and CT, and MRI examination. 12 patients received open reduction and internal fixation, intraoperative fracture with absorbable screw combined with anatomic plate fixation. After treatment, fracture healing and the knee joint function recovery were observed during follow-up.
RESULTS AND CONCLUSION: All patients were followed up for 16-48 months. Fractures were healed. No loosening or fracture re-displacement occurred. Flexion range of knee joint was from 110° to 135°. According to Leteneur’s functional assessment system, there were excellent in 9 cases, good in 2 cases, fair in 1 case with the excellent and good rate of 92%. The absorbable screw fixation can realize the entirety of articular surface of crushed bone. The absorbable screw fixation combined with anatomic plate is effective in treatment of medial condyle Hoffa fracture, which further strengthened fixation. Its operation is convenient. Steel plate attachment is good, has some advantages, such as firm fixation, less complications, early functional exercises, and good repair effects. Thus, it can provide reference for the repair of above fractures.

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: Femur, Fractures, Bone, Internal Fixators, Fracture Healing, Follow-Up Studies

CLC Number:

R318

Qiu Chang-mao, Liu Hong-zhi, Zhang Yin-guang, Liu Zhao-jie, Tian Wei, Jia Jian. Absorbable screws and anatomical plate of medial femoral condyle for treatment of medial condyle Hoffa fractures: good steel plate attachment and firm fixation[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1400-1404.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，纳入股骨内侧髁Hoffa骨折患者12例，均获得满意随访，随访时间16-48个月，无脱落。 2.2 患者一般资料 12例股骨内侧髁Hoffa 骨折患者基本资料见表1。 2.3 膝关节功能评分按Letenneur 等的Hoffa骨折术后功能恢复评估标准评定，本组获优9例，良2例，可1例。评价为可的患者主要表现为屈曲受限(约110°)并偶有疼痛，为陈旧性骨折行二次手术患者。 2.4 影像学检查结果所有骨折均骨性愈合，愈合时间为8-20周，平均14周；无内固定物松动及螺钉断裂等并发症发生，均于术后16-20个月取出内固定物。末次随访时1例陈旧性骨折患者骨性关节炎明显，其余患者膝关节X射线片未见明显关节炎表现。 2.5 并发症术后伤口均一期愈合，无感染发生；2例患者术前下肢血管彩超示小腿肌间静脉血栓，术后2周复查血栓再通；所有病例均未发生骨坏死、骨折不愈合、膝关节僵直；其他合并骨折均得到满意治疗效果。 2.6 典型病例男性患者，21岁，2013-04-10不慎从3 m高处坠落，当时出现左膝及左肩部肿痛、活动受限，遂就诊于本院急诊，X射线检查示：左股骨内侧髁Hoffa骨折、右肩胛骨骨折。为进一步治疗收入本科病房。体格检查结果示：左膝关节肿痛、屈曲畸形，浮髌试验(+)，抽屉实验(+)，外翻实验(+)，肢端血运及感觉正常；左肩部活动受限、压痛明显。入院后行左膝关节CT、MRI及左肩胛骨三维CT检查，结果显示：左股骨内侧髁Hoffa、左膝前交叉韧带断裂、左膝外侧半月板前角损伤、左内侧副韧带抵止点损伤、右肩胛骨骨折。给予左下肢支具伸直位固定，消肿止痛等处理。待病情稳定后，于2013-04-18全麻下行右肩胛骨骨折切开复位内固定治疗。后于2013-04-25在腰硬联合麻醉下左股骨内侧髁Hoffa骨折切开复位解剖钢板内固定治疗。术后膝关节在可活动支具保护下，指导患者锻炼屈伸功能，膝关节功能恢复良好，术后18个月取出内固定，复查X射线片：骨折线消失，无创伤性关节炎表现，见图1。"

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