Hoffa fractures are associated with concomitant soft tissue injures and a high postoperative complication rate.

Autor: Neumann-Langen MV; Department of Orthopaedic Trauma Surgery, Klinikum Konstanz, Mainaustrasse 35, 78464, Constance, Germany. Mirjam.langen@glkn.de.; Department of Orthopaedic and Trauma Surgery, University Hospital of Freiburg, Hugstetter Strasse 55, 79104, Freiburg, Germany. Mirjam.langen@glkn.de., Eggeling L; Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany., Glaab R; Department of Orthopaedics and Traumatology, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland., von Rehlingen-Prinz F; Department of Orthopaedic and Trauma Surgery, Universitätsklinikum Hamburg-Eppendorf, Gebäude O10, Martinistrasse 52, 20246, Hamburg, Germany., Kösters C; Department of Orthopaedic and Trauma Surgery, Maria-Josef-Hospital Greven, Lindenstrasse 29, 48268, Greven, Germany., Herbst E; Department of Orthopaedic and Trauma Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 Feb; Vol. 144 (2), pp. 747-754. Date of Electronic Publication: 2023 Dec 13.
DOI: 10.1007/s00402-023-05133-0
Abstrakt: Introduction: Hoffa fractures are a rare and often overlooked entity. The main goal of surgical treatment is to restore the articular surface and maintain knee function. However, current clinical data indicate heterogeneous outcomes. The aim of this multicenter study was to obtain a representative data set of patients with isolated Hoffa fractures with special emphasis on concomitant soft tissue injuries, diagnostic algorithms, treatment strategies and functional outcomes.
Materials and Methods: Participating Level I trauma centres were asked to review their internal database for isolated Hoffa fractures treated surgically between 2010 and 2020. Demographics, mechanism of injury, diagnostic and therapeutic algorithm, Letenneur classification, concomitant soft tissue injuries, and postoperative knee function and complications were analysed.
Results: A total of 56 patients from six participating trauma centres were included. The median age at injury was 45 years (15-94) with a median follow-up of 19 months (2-108). The most common mechanism of injury was high-energy trauma, with unicondylar lateral Letenneur type I and II fractures being the most common. Surgical treatment was independent of the type of fracture and included isolated screw fixation, combined plate and screw fixation and isolated plate osteosynthesis. Isolated screw fixation resulted in significantly better range of motion (ROM) values (p = 0.032), but the highest number of postoperative complications (n = 14/20, n.s.) compared to the other fixation techniques. The highest number of fixation failures requiring revision was observed in the plate and screw fixation group (n = 3/8, p = 0.008). Osteochondral flake fractures (n = 12/43, 27%) and lateral meniscus injuries (n = 5/49, 10%) were commonly seen in Hoffa fractures.
Conclusions: Treatment of Hoffa fractures with screw fixation resulted in significantly better functional outcomes, probably due to less comminuted fractures. Concomitant cartilage, meniscal and ligamentous injuries are common and warrant preoperative recognition and management.
(© 2023. The Author(s).)
Databáze: MEDLINE
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