PURPOSE: Hoffa fracture is a femoral condyle fracture in the coronal plane. The lateral condyle is more commonly involved. The diagnosis is often difficult to detect with routine radiographs. Conservative management in this type of fracture resulted in nonunion, malunion, and other complications, such as stiff knee. Therefore, surgical management is mandatory in displaced fractures. Previous studies suggest only application of cancellous screw fixation, but these are not enough to counter vertical shear stress. Therefore, this study will evaluate the clinical outcomes of open reduction and internal fixation of Letenneur type I Hoffa fracture using cancellous screws with posterior buttressing plate. METHOD: This was a prospective cohort study conducted from March 2017 to July 2022 in orthopaedics department of tertiary care center after approval of institutional ethical committee. The study included 36 patients with Letenneur type I fractures treated by open reduction and internal fixation using posterior buttress plate and cancellous screws. Radiographs and clinical outcomes, range of movement (ROM), bone union, and knee society score (KSS) of patients were assessed at the end of 4 and 12 months in the follow-ups. All statistical analysis was done using Epi info version 7.2.1.0. RESULTS: In the 36 patients with Letenneur type I fracture, the majority belong to younger age group between 25 and 54 years with 22 males and 14 females. The modes of injury were road traffic accidents in 25 patients and fall from height in 11 patients. The right knee was involved in 21 cases and left was involved in 15 cases. Lateral condyle involvement was seen in 27 cases and medial condyle in 9 cases. All 36 patients with Letenneur type I Hoffa fracture were evaluated 4 months after surgical intervention. The notable improvements were observed in terms of ROM 120.4° ± 5.0° and KSS 85.0 ± 4.2. At the 12-month follow-up, considerably better outcomes were maintained regarding ROM 128.1° ± 5.2° and KSS 89.3 ± 4.8 with p < 0.05 which was statistically significant. At the final follow-up, all patients had routine fracture healing with a union time of (3.2 ± 3.4) months. CONCLUSIONS Fixation of Letenneur type I Hoffa fracture with cancellous screws and posterior buttress plate is effective, reliable and capable of providing adequate stability. Buttress plate assisted fixation is a valuable enhancement of the conventional technique of lag screw fixation of Hoffa fractures.
Humans ; Bone Plates ; Male ; Female ; Fracture Fixation, Internal/instrumentation* ; Adult ; Prospective Studies ; Middle Aged ; Femoral Fractures/surgery* ; Bone Screws ; Range of Motion, Articular ; Young Adult ; Aged ; Hoffa Fracture

Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.
Amputees ; Femoral Neck Fractures/surgery* ; Femur ; Fracture Fixation, Internal ; Humans ; Lower Extremity

Bipolar clavicular dislocation is rare, and therefore its management is contentious. With an increase of patient’s physical demand and a near-normal shoulder function, there has been a shift in the paradigm of its management from a conservative one to a stabilized one of anatomical open reduction. Proposed methods of fixation have also evolved with the advent of more biological fixation devices, which elude implant or fixation related complications. This case report highlights the salient features of this rare case and details the management options along with the benefits of biological anatomical repair and reconstruction.