Plate fixation for Letenneur type I Hoffa fracture: a biomechanical study |
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| Institution: | 1. Orthopaedic and Trauma Surgery Department, Hospital Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Catalonia Spain;2. Department of Experimental and Health Sciences, Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain;1. Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, United States;2. National Farm Medicine Center, Marshfield Clinic Research Foundation, United States;3. Division of Research, Essentia Institute of Rural Health, United States;4. Department of Medicine and Public Health, University of Washington and Veterans Administration Puget Sound Health Care System, United States;1. UNC –Project Malawi, Lilongwe, Malawi;2. University of Louisville School of Medicine, Louisville, KY, United States;3. Department of Surgery, University of North Carolina, Chapel Hill, NC, United States;4. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi;5. Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, United States;1. Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China;2. Experimental Surgery and Regenerative Medicine, Department of Surgery, Ludwig Maximilians University, Munich, Germany;1. Department of Pelvic and Acetabular Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi''an, China;2. Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA |
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| Abstract: | BackgroundA coronal fracture of the posterior femoral condyle, also known as a Hoffa fracture, is an unusual injury, and there are only a handful of case reports or series exploring it. The optimal fixation method of these intraarticular fractures remains controversial; improper or unstable fixation usually lead to an unsatisfactory prognosis. The use of posterior–anterior or reversed lag screw fixation is still a popular method. Additional buttress plating is also recommended for fixation of these difficult fractures. The purpose of this study was to compare the mechanical strength of four different fixation patterns for this uncommon fracture.Material and methodsSixteen sawbone simulated models of Letenneur type I Hoffa fractures were created with one of four fixation patterns: two screws implanted in the anterior–posterior (AP) direction or posterior–anterior (PA) direction; one screw in the PA direction with a plate implanted in the posterior position of the distal femoral condyle or with a plate in the lateral position. Biomechanical testing was performed to determine the post-fixation axial stiffness, the maximum load to failure and the fragment vertical displacement for each of the four constructs.ResultsThe plate fixation patterns whether implanted in the posterior or lateral position were shown to provide higher overall axial stiffness and load to failure, and less vertical displacement than the other two patterns of pure screw fixation. Among these constructs, the lateral plate fixation was found to provide the highest stiffness and load to failure and the least displacement for the posterior condylar fragments, followed by the posterior plate fixation. The lowest overall stiffness and load to failure and the largest vertical displacement were found in the construct with the AP direction placed screws.ConclusionIt was concluded that the lateral position implanted plate is biomechanically the strongest fixation method for Letenneur type I Hoffa fractures. However, this plate fixation is not recommended for all cases. The choice of internal fixation pattern depends on the surgeons. |
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| Keywords: | Hoffa fracture Letenneur classification Internal fixation Biomechanics |
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