Open fracture-dislocation of the knee associated with nonunion of the medial femoral condyle and chronic tendon patellar rupture

Main Article Content

Filippo Calderazzi
Alberto Visigalli
Giacomo Scita
Alessandro Spirito
Umberto Ferrari
Francesco Ceccarelli
Francesco Pogliacomi

Keywords

Nonunion, Hoffa, synthesis, patellar tendon, patellar distalization.

Abstract

Background and aim of work:


The incidence of coronal fractures of the femoral condyle, Hoffa fractures, ranges from 8.7% to 13% of all fractures of the distal femur and are often observed in polytraumas.


Hoffa fractures may be misdiagnosed and consequently not properly treated. Reduction and synthesis of this type of fracture should be achieved to avoid complications such as nonunion, pain, functional impairment.


The authors present a case of a 5 year old nonunion of a Hoffa fracture of the medial condyle with chronic patellar tendon rupture.


 


Methods:


Revision surgery consisted of reduction and fixation of the Hoffa fracture with screws associated with bone grafting from the iliac crest. Distalization of the patella by Z-plasty and reconstruction of the patellar tendon with Achille's allograft were also performed.


 


Results:


Clinical evaluation after 10 months following the end of the treatment showed a complete resolution of pain, almost complete range of motion, good strength and almost complete functionality of the operated limb.


 


Conclusions


Mistakes in the diagnosis or treatment of Hoffa fracture can often result nonunion, functional impairment, and persistent pain.


To avoid these, the senior authors of this text believe that the correct treatment of acute Hoffa fracture and its potential associated injuries are crucial, according to the concept of early damage control and later synthesis with soft tissue reconstruction.

Downloads

Download data is not yet available.
Abstract 172 | PDF Downloads 116

References

1. Jiang YR, Wang ZY, Zhang DB, Gu GS, Twenty-seven-year nonunion of a Hoffa fracture in a 46-year-old patient, Chinese journal of traumatology, 2015,18(1), 54-58
2. Zhou Y, Pan Y, Wang Q, Hou Z, Chen W. , Hoffa fracture of the femoral condyle: Injury mechanism, classification, diagnosis, and treatment, Medicine, 2019 Feb;98(8)
3. Pathak S, Salunke A, Karn S, et al., Hoffa Fracture with Associated Injuries Around the Knee Joint: An Approach to a Rare Injury, Cureus, April 28, 2020,12(4)
4. Stannard J, Fracture Dislocation of the Knee, J Knee Surg., May, 2016, 29(4):300-2
5. Maslaris A, Brinkmann O , Bungartz M , Krettek C , Jagodzinski M ,Liodakis E , Management of knee dislocation prior to ligament recostruction: what is the current evidence? Update to universal treatment algorithm, Eur J Orthop surg Traumatol, 2018 Aug;28(6):1001-1015
6. Falconiero RP, Pallis, MP, Chronic rupture of a patellar tendon: a technique for recostruction with Achilles allograft, Arthroscopy,1996,Oct;12(5):623-6 .
7. Lewis P, Rue, JP, Bach, B, Chronic Patellar Tendon Rupture – Surgical Reconstruction Technique Using 2 Achilles Tendon Allografts, The Journal of Knee Surgery, 2010, 21(02), 130–135
8. Zhang, P, Zhang, X, Tao, F, Li, Q, Zhou, D, Liu, F ,Surgical Treatment and Rehabilitation for Hoffa Fracture Nonunion: Two Case Reports and a Literature Review, Orthopaedic Surgery, 2020,Aug12(4):1327-1331
9. Öztürk, A, Özkan, Y, & Özdemir, R M , Nonunion of a Hoffa fracture in an adult, musculoskeletal, 2009,93(3), 183–185,
10. Chouhan D, Hooda A, Rana A, Non-union lateral femoral condyle Hoffa fracture: a case report, Int J Burns Trauma, 2020, 10(6): 338–344
11. Jiang YR, Wang ZY, Zhang DB, Gu GS, Twenty-seven-year nonunion of a Hoffa fracture in a 46-year-old patient, Chinese journal of traumatology, 2015,18 54-58
12. Lamberti, A., Balato, G., Summa, P. P., Rajgopal, A., Vasdev, A., & Baldini, A. , Surgical options for chronic patellar tendon rupture in total knee arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, 20116, 26(5)
13. Lu, B., Zhao, S., Luo, Z., Lin, Z., & Zhu, Y., Compression screws and buttress plate versus compression screws only for Hoffa fracture in Chinese patients: a comparative study, Journal of International Medical Research, 2019 Jan,47(1):142-151
14. McNally PD, et al, Achilles allograft recostruction of a chronic tendon rupture, Arthroscopy, 1998 Apr,14(3):340-4
15. Karadimas, J. E., Piscopakis, N., & Syrmalis, L., Patella Alta and chondromalacia, International Orthopaedics, 1981,5(4):247-9

Most read articles by the same author(s)

1 2 3 4 5 6 7 > >>