Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of thr...Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union wasachieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed.展开更多
A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion ofa Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion ofa Hoffa...A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion ofa Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion ofa Hoffa fracture have been documented in the literature to date, including two children and one adult. This article presents a case of an adult who had nonunion of a Hoffa fracture for 27 years and was treated by open reduction and internal fixation, and the varus deformity corrected with xenogenous bone graft. An excellent result has been achieved to date. This unusual case reminds us that we cannot neglect the possibility of nonunion of a cancellous hone fracture, especially the Hoffa fractures of the medial femoral condyle if they are treated nonoperatively. It also demonstrates that internal fixation with bone graft is effective, even for the 27-year Hoffa fracture.展开更多
Intraarticular nonunion of tibial plateau is rare. In the literature, only 9 patients were found to be treated for intraarticular tibial plateau nonunion and they got varying results. Internal fixation along with bone...Intraarticular nonunion of tibial plateau is rare. In the literature, only 9 patients were found to be treated for intraarticular tibial plateau nonunion and they got varying results. Internal fixation along with bone grafting was done as a standard treatment in all cases. We treated 4 different profile cases of intraarticular tibial plateau nonunion in our institution by 4 different methods. We treated these cases with plaster of paris cast, internal fixation along with bone graft, arthrodesis with K-nail and total knee replacement. Case 1 was treated with plaster of paris (POP) cast as the patient refused surgery. The fracture was united and the patient was fully satisfied with full range of motion despite valgus malalignment. Case 2 was managed with open reduction internal fixation along with bone grafting. Thepatient had a good union and got full range of motion at the knee joint. Case 3 was treated with total knee arthroplasty due to her old age and got satisfactory result. Case 4 was an infected nonunion. Arthrodesis was done and the patient could walk with full weight bearing independently. We conclude that internal fixation along with bone grafting may not be suitable in all cases of intraarticular nonunion of tibial plateau. Causes of nonunion, present condition and range of motion of the knee joint, as well as the age of patient should be all considered and the treatment should be individualised according to each patient's situation.展开更多
Objective: Management of mallet fractures is still a matter of discussion throughout the literature. For some authors, mallet fractures involving more than 1/3 of the articular surface and palmar subluxation of the d...Objective: Management of mallet fractures is still a matter of discussion throughout the literature. For some authors, mallet fractures involving more than 1/3 of the articular surface and palmar subluxation of the distal phalanx require surgical treatment. In this study we retrospectively compared three different techniques for mallet fractures: Kirschner wire fixation with extension block pinning (EBP) of the distal interphalangeal joint, Kirschner wires used as joysticks (KWJ) and interfragmentary miniscrews for open reduction and internal fixation (ORIF). Methods: Fifty-eight mallet fractures with palmar subluxation in 58 patients were treated with the aforementioned surgical techniques. Twenty mallet fractures in 20 patients 18 to 70 years old (average 42 years) were operated upon by EBP, 16 patients 22 to 56 years old (average 56 years) were operated upon using KWJ and 22 patients 22 to 54 years old (average 36 years) received OR/F. Follow-up time was 6 to 58 months (average 21 months). The following intraoperative parameters were considered: intraoperative time, number of Kirschner wires/screws and technical problems. Postoperative parameters included work absence and complications. The radiological evaluation was based on A-P and lateral views preoperatively and interviews at follow-up time. Bone union was defined by radiological evidence of bone trabeculae crossing the fracture site on at least one view. Clinical evaluation involved range of motion (ROM) test with a goniometer. Based on these measurements, a functional Crawford score was established. Results: All fractures healed. In the KWJ group, intraoperative time was shorter and total ROM was wider (72° vs 58° and 54 °); in the ORIF group, return to work was faster (2.7 weeks vs 7.2 weeks and 6 weeks) but a little higher complication rate due to screw positioning has been found. Functional results as to total ROM, distal interphalangeal lag extension and Crawford classification were similar. Conclusions: We demonstrate the advantages of the use of the three techniques and bone consolidation in all cases with no signs ofosteoarthritis. Screw fixation is more technically demanding (longer intraoperative time and more complications) but allows earlier mobilization and faster returning to work. EBP and KWJ techniques are faster to perform with no complications but require a careful management of the pin tracts. There is no statistically significant difference as to functional results.展开更多
文摘Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union wasachieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed.
文摘A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion ofa Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion ofa Hoffa fracture have been documented in the literature to date, including two children and one adult. This article presents a case of an adult who had nonunion of a Hoffa fracture for 27 years and was treated by open reduction and internal fixation, and the varus deformity corrected with xenogenous bone graft. An excellent result has been achieved to date. This unusual case reminds us that we cannot neglect the possibility of nonunion of a cancellous hone fracture, especially the Hoffa fractures of the medial femoral condyle if they are treated nonoperatively. It also demonstrates that internal fixation with bone graft is effective, even for the 27-year Hoffa fracture.
文摘Intraarticular nonunion of tibial plateau is rare. In the literature, only 9 patients were found to be treated for intraarticular tibial plateau nonunion and they got varying results. Internal fixation along with bone grafting was done as a standard treatment in all cases. We treated 4 different profile cases of intraarticular tibial plateau nonunion in our institution by 4 different methods. We treated these cases with plaster of paris cast, internal fixation along with bone graft, arthrodesis with K-nail and total knee replacement. Case 1 was treated with plaster of paris (POP) cast as the patient refused surgery. The fracture was united and the patient was fully satisfied with full range of motion despite valgus malalignment. Case 2 was managed with open reduction internal fixation along with bone grafting. Thepatient had a good union and got full range of motion at the knee joint. Case 3 was treated with total knee arthroplasty due to her old age and got satisfactory result. Case 4 was an infected nonunion. Arthrodesis was done and the patient could walk with full weight bearing independently. We conclude that internal fixation along with bone grafting may not be suitable in all cases of intraarticular nonunion of tibial plateau. Causes of nonunion, present condition and range of motion of the knee joint, as well as the age of patient should be all considered and the treatment should be individualised according to each patient's situation.
文摘Objective: Management of mallet fractures is still a matter of discussion throughout the literature. For some authors, mallet fractures involving more than 1/3 of the articular surface and palmar subluxation of the distal phalanx require surgical treatment. In this study we retrospectively compared three different techniques for mallet fractures: Kirschner wire fixation with extension block pinning (EBP) of the distal interphalangeal joint, Kirschner wires used as joysticks (KWJ) and interfragmentary miniscrews for open reduction and internal fixation (ORIF). Methods: Fifty-eight mallet fractures with palmar subluxation in 58 patients were treated with the aforementioned surgical techniques. Twenty mallet fractures in 20 patients 18 to 70 years old (average 42 years) were operated upon by EBP, 16 patients 22 to 56 years old (average 56 years) were operated upon using KWJ and 22 patients 22 to 54 years old (average 36 years) received OR/F. Follow-up time was 6 to 58 months (average 21 months). The following intraoperative parameters were considered: intraoperative time, number of Kirschner wires/screws and technical problems. Postoperative parameters included work absence and complications. The radiological evaluation was based on A-P and lateral views preoperatively and interviews at follow-up time. Bone union was defined by radiological evidence of bone trabeculae crossing the fracture site on at least one view. Clinical evaluation involved range of motion (ROM) test with a goniometer. Based on these measurements, a functional Crawford score was established. Results: All fractures healed. In the KWJ group, intraoperative time was shorter and total ROM was wider (72° vs 58° and 54 °); in the ORIF group, return to work was faster (2.7 weeks vs 7.2 weeks and 6 weeks) but a little higher complication rate due to screw positioning has been found. Functional results as to total ROM, distal interphalangeal lag extension and Crawford classification were similar. Conclusions: We demonstrate the advantages of the use of the three techniques and bone consolidation in all cases with no signs ofosteoarthritis. Screw fixation is more technically demanding (longer intraoperative time and more complications) but allows earlier mobilization and faster returning to work. EBP and KWJ techniques are faster to perform with no complications but require a careful management of the pin tracts. There is no statistically significant difference as to functional results.