Abstract：Objective To summarize the clinical features of Hoffa fractures and to investigate the surgical strategies and curative effect.Methods The study enrolled 18 patients with Hoffa fractures treated from January 2007 to December 2011.All the patients were male,at a mean age of 36.8 years (range,18-58 years).There were 17 patients with fresh fractures and 1 with old fracture nonunion.Lateral condylar fractures occurred in 8 patients and medial condylar fractures in 10.According to Letenneur' s classification,9 fractures were type Ⅰ,3 type Ⅱ and 6 type Ⅲ.Open reduction and internal fixation was performed,including 13 patients being fixed with 2-3 cannulated screws of 4.5 mm via anterior approach and 5 patients with 2-4 headless compression screws of 2.4,3.0 or 4.0 mm via posterior approach.Results Three patients were misdiagnosed at the first visit with a missed diagnosis rate of 17％ (3/18),but were later confirmed in CT scanning.Fourteen patients were followed up for a mean period of 24 months (range,12-60 months),with bony healing in average 12 weeks (range,8-24 weeks).There were no complications of infections,deep vein thrombus,reduction loss,or implant failure.According to Letenneur' s assessment system,the outcome was excellent or good in 11 patients,fair in 2,and poor in 1.Conclusions Early anatomical open reduction and rigid internal fixation are key to successful treatment.Surgical approaches and types,diameters as well as entry directions of screws should be determined with reference to the fracture type,size of fracture fragment and presence or absence of comminution.
［4］Thakar C. The Hoffa fracture—a fracture not to miss［J］. Emerg Med J, 2010, 27(54):391-392.
［5］Iwai T, Hamada M, Miyama T, et al. Intra-articular corrective osteotomy for malunited Hoffa fracture:a case report［J］. Sports Med Arthrosc Rehabil Ther Technol, 2012, 4(1):28-32.
［6］Lewis SL, Pozo JL, Muirhead-Allwood WF. Coronal fractures of the lateral femoral condyle［J］. J Bone Joint Surg Br, 1989, 71(1):118-120.
［7］Tripathy SK,Aggarwal A,Patel S,et al.Neglected hoffa fracture in a child［J］. J Pediatric Orthop B, 2013, 22(4):339-343.
［8］Dua A, Shamshery PK.Bicondylar Hoffa fracture:open reduction internal fixation using the swashbuckler approach［J］. J Knee Surg, 2010, 23(1):21-24.
［9］Liebergall M, Wilber JH, Mosheiff R, et al. Gerdy’s tubercle osteotomy for the treatment of fractures of the lateral femoral condyle［J］. J Orthop Trauma, 2000, 14(3):214-215.〖ZK)〗
［10］Letenneur J, Labour PE, Rogez JM, et al. Fractures de Hoffa:a propos de 2 observations［J］. Ann Chir, 1978, 32(3-4):213-219.
［11］Dhillon MS, Mootha AK, Bali K, et al. Coronal fractures of the medial femoral condyle:a series of 6 cases and review of literature［J］. Musculoskelet Surg, 2012, 96(1):49-54.
［12］Lal H, Bansal P, Khare R, et al. Conjoint bicondylar Hoffa fracture in a child:a rare variant treated by minimally invasive approach［J］. J Orthop Traumatol, 2011, 12(2):111-114.
［13］Crist BD, Della Rocca GJ, Murtha YM, et al. Treatment of acute distal femur fractures［J］. Orthopedics, 2008, 31(7):681-690.
［14］Miyamoto R, Fornari E, Tejwani NC. Hoffa fragment associated with a femoral shaft fracture［J］. J Bone Joint Surg Am, 2006, 88(10):2270-2274.
［15］Gong YB, Li QS, Yang C, et al. Hoffa fracture associated with ipsilateral femoral shaft fracture:clinical feature and treatment［J］. Clin J Traumatol, 2011, 14(6):376-378.
［16］Vaishya R, Singh AP, Dar IT, et al. Hoffa fracture with ipsilateral patellar dislocation resulting from household trauma［J］. Can J Surg, 2009, 52(1):E3-E4.
［17］Nork SE, Segina DN, Aflatoon K, et al. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures［J］. J Bone Joint Surg Am, 2005, 87(3):564-569.
［19］McCarthy JJ, Parker RD. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral condyle fracture of the knee. Arthroscopy, 1996, 12(2):224-227.
［20］Mounasamy V, Zuelzer WA. A novel approach to fix an avulsion fracture of posterior cruciate ligament from the tibia when associated with a type C distal femoral fracture and a hoffa fracture:a case report［J］. Eur J Orthop Surg Traumatol, 2012, 22(3):251-254.
［21］Hak DJ, Nguyen J, Curtiss S, et al. Coronal fractures of the distal femoral condyle:a biomechanical evaluation of four internal fixation constructs［J］. Injury, 2005, 36(9):1103-1106.
[22]Westmoreland GL, McLaurin TM, Hutton WC. Screw pullout strength:a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau［J］.J Orthop Trauma, 2002, 16(3):178-181.
［23］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］. J Orthop Trauma, 2006, 20(4):273-276.
