Nonunion of a Hoffa fracture in an adult

The coronal fractures of femoral condyles, known as Hoffa fractures, are a rarity. Conservative management often leads to unsatisfactory results and nonunion. In this study, we present a case of a 35-year-old patient with an established nonunion of medial Hoffa fracture of right knee treated with open reduction and internal fixation.     

Nonunion of a carpal scaphoid fracture in a child

We report a case of a nonunion of a carpal scaphoid in a child treated successfully by cast immobilization. Contrary to the general opinion that nonunion of the scaphoid bone should be treated operatively, even in children, we showed that healing can be obtained by nonoperative treatment methods.     

Hoffa fracture in a 14-year-old

Coronal shear fractures of the femoral condyle (ie, Hoffa fracture) are an uncommon clinical entity typically seen in adults after higher-energy trauma. Historically poor outcomes have been reported in the literature with nonoperative treatment of these fractures. Conversely, open reduction and internal fixation of these fractures has been shown to produce good long-term clinical results in adults. These fractures appear to be even more uncommon in skeletally immature patients, with only 3 case reports documented in the literature to date. Two of the 3 cases presented as a symptomatic nonunion after initial nonoperative treatment. Herein we present a case report of a Hoffa fracture of the lateral femoral condyle in a 14-year-old boy after a wrestling injury. The fracture was treated with diagnostic arthroscopy followed by conversion to an arthrotomy for open reduction and internal fixation. Rigid fixation of the fracture was obtained with 4 headless compression screws. Twelve months postoperatively, the fracture was radiographically healed and the patient was pain free with restoration of full knee motion and return to sporting activity. The Hoffa fracture is a unique and relatively uncommon clinical entity that has a different personality than other intra-articular fractures of the knee in both adults and children. Instability of the fracture fragment can lead to a higher likelihood of nonunion with persistent pain and disability. These fractures should be treated with open reduction and internal fixation to achieve anatomic reduction with stable fixation and preservation of the blood supply to achieve early, active mobilization. We believe this optimizes the chance for good long-term functional results.     

Conjoint bicondylar Hoffa fracture in a child: a rare variant treated by minimally invasive approach

A case of conjoint Hoffa-type fracture in a child is presented. Hoffa fracture, i.e., coronal slice fracture of the condyles of the femur, is rare in adults and even rarer in the pediatric population. To date, no case of conjoint bicondylar Hoffa fracture has been reported in the literature. The presented case was successfully treated by arthroscopically assisted internal fixation.     

Hoffa骨折的治疗

股骨单髁或双髁冠状面骨折,在四肢骨折中发生率低,但其属关节内骨折,合理的治疗关系到膝关节功能的恢复,故值得重视.1996年1月～2005年10月,我科收治Hoffa骨折患者12例,10例切开复位内固定,2例非手术治疗,均取得较好效果.     

Hoffa骨折的治疗

2004年2月～2011年6月,我科手术治疗12例股骨外髁冠状面骨折患者,疗效满意。1材料与方法1.1病例资料本组12例,男9例,女3例,年龄20～57岁。其中2例合并胫骨平台骨折,1例合并前交叉韧带股骨     

手术治疗Hoffa骨折

目的探讨Hoffa骨折的治疗方法及临床疗效。方法采用切开复位内固定术治疗18例Hoffa骨折患者。结果患者均获随访,时间12~24(18±4.2)个月。骨折全部愈合,时间3.6~4.8(3.9±0.3)个月。按照Letenneur et al评分系统进行评估:优10例,良6例,可2例。结论切开复位内固定治疗Hoffa骨折有利于恢复股骨髁的完整性,有利于膝关节早期功能锻练,可减少创伤性关节炎的发生。     

伴软骨损伤的Hoffa骨折1例

患者,男,31岁,2019年11月29日因扭伤致右膝部疼痛肿胀、膝关节活动受限,于当地医院诊断为右股骨外侧髁骨折.为进一步治疗,于2019年12月3日至山东省中医院就诊,诊断为右Hoffa骨折.CT 检查显示:右股骨外侧髁骨折,右膝关节积液.MRI 显示:① 右膝关节积液;② 右股骨远端外髁骨折,右胫骨近段及髌骨有骨挫...     

Nonunion in a distal radius metaphyseal fracture in a child: Role of intact periosteal sleeve in management

We present an adolescent with distal radius nonunion following an open fracture and failed surgery which eventually united when the length and stability was restored for eight weeks duration. The intact periosteal sleeve at the nonunion site formed new bone when its tension was restored by gradual differential distraction. This case report highlights the possibility of stimulating bony union in an established atrophic nonunion by distracting the minimally disturbed soft tissue and thick osteogenic periosteal envelope in the paediatric age group.     

Nonunion of a complex tibial plateau fracture

Nonunion of tibial plateau fractures are uncommon; only five cases have been reported in the literature. This report presents the sixth nonunion and highlights the management of an angulated, periarticular pseudoarthrosis. Pitfalls in the initial fracture treatment that contributed to the development of the pseudoarthrosis are reviewed.     

Twenty-seven-year nonunion of a Hoffa fracture in a 46-year-old patient

A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion of a Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion of a 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 bone 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.     

股骨髁冠状面骨折非手术治疗1例报告

男性患者,37岁,2007年11月因车祸伤致右膝关节疼痛,活动受限1.5h来诊。体格检查：右膝关节半屈曲位,肿胀明显,股骨内髁压痛,右膝关节活动受限,远肢端血运感觉及活动情况均正常。X线片示：右股骨内髁孤立性骨折,     

Conjoint bicondylar Hoffa fracture in an adult

Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT) scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior) approach. Union occurred within 3 months and at final followup (at 18 months) the patient had a good clinical outcome. The possible mechanism of injury is discussed.     

Nonunion as a complication of an open reduction of a distal radial fracture in a healthy child: a case report

Nonunion of a distal radial fracture is rare in children. We report one referred case of a nonunion of the distal radius after an open reduction. The patient is a 10-year-old healthy male with a displaced bicortical fracture of the distal radius and an undisplaced ulnar fracture. This fracture was initially treated by the referring orthopedist with open reduction and single Kirschner wire fixation, as closed reduction was thought to be difficult to achieve. The patient was seen with a distal radius nonunion at 14 months following the initial procedure. A complete workup revealed a healthy child with no general or local pathologies. He was treated with open reduction of the nonunion site, correction of angular deformity, and plate fixation. This resulted in bony union with no limitation of motion. Potential reasons for the development of nonunion and suggestions to avoid this complication are discussed.     

Nonunion of forearm fracture: a rare instance in a toddler

When compared to adults, pediatric fractures unite readily and nonunion is quite rare. Nonunion is often associated with open fractures, operative interventions, infection, pediatric osteogenesis imperfecta and neurofibromatosis. There are only a few studies and reports mentioning nonunion following conservative management of closed pediatric fractures. We report here a case of an eighteen-month-old child who developed nonunion following treatment of fracture of both forearm bones with cast and was successfully treated with plating. To the best of our knowledge, this is the youngest reported case of nonunion following conservative management of closed diaphyseal pediatric fracture.     

Hoffa骨折的CT分型

目的 介绍一种新的Hoffa骨折CT分型,并对Hoffa骨折的CT分型与Letenneur X线分型的组间一致性进行比较. 方法 随机选取2008年1月至2011年12月收治的20例Hoffa骨折患者的影像学资料(膝关节正、侧位X线片和股骨髁CT三维重建片),呈递给20位由高级、中级和初级临床医师组成的阅片者,以同样的流程分别根据Letenneur X线分型和新的CT分型对Hoffa骨折进行分类,采用加权Kappa系数进行组内一致性检验,比较多个阅片者之间的两种分型的一致性. 结果 20位阅片者对20例Hoffa骨折患者的CT分型:Ⅰ型占66.0％,Ⅱ型占30.5％,Ⅲ型占3.5％.Ⅰ型骨折中涉及b区域的Ⅰb型最多,占50.0％,Ⅰa型占19.0％,Ⅰc型占31.0％；Ⅱ型粉碎性骨折中粉碎骨折块也多出现在b区域；涉及b区域的骨折在CT分型中总的发生率是67.0％.X线分型:Ⅰ型占31.4％,Ⅱ型占14.3％,Ⅲ型占28.0％,Ⅳ型占26.3％.多个阅片者之间CT分型一致性(Kappa=0.681)较X线分型更高(Kappa=0.261).结论 对于Hoffa骨折,新的CT分型一致性优于X线分型,尤其对于粉碎性骨折患者.     

The Hoffa fracture: Three case reports

Unicondylar fractures of the lower end of the femur are uncommon injuries that usually occur in the saggital plane 2. Coronal (tangential) plane fractures, first described by Hoffa in 1904, are unusual.(1,2, 3,4) We report our experience with three cases and the mechanism of injury is discussed. Open reduction and internal fixation is mandatory for good long-term results.     

A new fixation method for Hoffa fracture

Purpose

To investigate the clinical effect of a new fixation method for Hoffa fractures.

Methods

We treated eleven patients with Hoffa fracture using the new fixation method (fixation with one screw inserted from the femoral intercondylar notch and two screws inserted from the nonarticular lateral (or medial) surface of the fractured condylar fragment; the two sets of screws were crossed).

Results

After an average follow-up period of 24 months (range 5–28 months), all fractures had healed. The average healing time was 11.6 weeks (range 9–14 weeks). On the version of the Knee Society Score modified by Dr. John Insall in 1993, the average score was 174.6 points (range 125–199 points).

Conclusions

The new fixation method for Hoffa fracture is effective, and may provide a new way to treat Hoffa fractures.