Clinical experience with management of Hoffa fractures using headless compression screw and headed screw

Abstract

Purpose: to analyze the radiological and functional outcomes of patients after surgical treatment of coronal plane fractures of femoral condyle using headless compression screw and cannulated cancellous (CC) screws (headed screws).

Material and method: In this prospective study 30 cases were included, out of which 15 were treated with headed screws and other 15 were treated with headless screws. Active knee mobilization exercises were started from the third postoperative day. Initially, patients were kept non-weight bearing; partial weight bearing was started at 10 weeks and progressed to full weight bearing as tolerated. Follow-up visits conducted at 2, 4 and 12 weeks, thereafter at 6 and 12 months. The long term final results were rated using Neer's rating system.

Results: Results were graded as excellent (score > 85), Satisfactory (score 71-85), Unsatisfactory (score 56-70), and Failure (score < 55). In CC screw group the outcome was good in 10 cases (66.66%) and poor in 5 cases (33.33%) whereas in headless group outcome was good in 13 cases (86.66%) and poor in 2 (13.33%).

Conclusion: fixation of Hoffa fracture with headless compression screw in comparison to CC screw (Headed Screw) have no significant difference in terms of functional outcome like range of motion but complications and implant failure is significantly higher in cases fixed with CC screw than in headless screw. So we conclude that overall outcome is better in study group fixed with headless compression screw as compared to cases fixed with CC Screw.

Fig. 1

A 45 year Male present with complaints of pain, swelling, inability to bear weight on the right lower limb following slip & fall A & B - Pre-operative X-ray AP and Lateral view C - NCCT Right knee coronal section D & E− Postoperative X-ray AP & Lateral View F & G- Clinical photograph with crossed knee and flexed knee @ 6months.

Fig. 2

A 34 year Male present with complaints of pain, swelling, inability to bear weight on the right lower limb following fall from height A & B—Pre-Operative X-ray AP & Lateral View C & D- Post-Operative X-ray Lateral & AP View E- Clinical photograph with Flexed Knee @ 6months.

Fig. 3

A 40 year Male present with complaints of pain, swelling, inability to bear weight on the left lower limb RTA A- Initial posttraumatic lateral radiographs of the knee B - A 3D reconstructed CT image of the femoral articular cartilage of the left knee, showing the bicondylar Hoffa fracture C & D- Intraoperative photographs illustrating the exposure of the bicondylar Hoffa fracture through a lateral parapatellar arthrotomy and provision reduction with Kirschner wires E & F— Anteroposterior (a) and lateral (b) radiographs obtained at the follow-up at 8 months after surgery.

Fig. 4

33 year Male present with complaints of pain, swelling, inability to bear weight on the left lower limb assault A- Pre-Op X-ray Lateral View B- Early Post-op X-ray Lateral View C & d-Late Post-op X-ray AP & Lateral View showing redisplacement of fracture.

Graph 1

Delayed Complications in headless and CC screw fixation.

Graph 2

Overall functional outcome according to fixation method.

Graph 3

Overall functional outcome according to Letenneur classification & mode of fixation.