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Hoffa Fragments in the Geriatric Distal Femur Fracture: Myth or Reality?

ABSTRACT: Previous research reported the frequency of coronal plane (Hoffa) fractures in high-energy supracondylar femur fractures in a relatively young population. It is the purpose of this study to identify the frequency of coronal plane fractures seen in elderly patients.All patients over the age of 18 years treated for supracondylar femur fractures at 2 level I trauma centers were reviewed over a 4-year period. The patients were stratified (?60 years and <60 years) and compared to determine differences in injury characteristics and fracture patterns with special attention to the prevalence of coronal plane fractures.One hundred ten patients were identified with supracondylar femur fractures (12 Orthopaedic Trauma Association [OTA] 33A; 2 OTA 33B; 96 OTA 33C). Thirty-two of the 96 intercondylar fractures were in patients >60 years of age. The elderly group included a higher percentage of females (81% vs 36%, P = .0001) and was more likely to sustain their injury due to a fall (59% vs 19%, P = .0001). Coronal plane fractures were visualized on computed tomography scans in 56 (58%) of the 96 33C femur fractures. Forty-four percent of elderly patients sustained a coronal plane fracture compared with 66% of the younger cohort (P = .04). The percentage of open fractures (30% elderly vs 46%) was not significantly different between the 2 groups (P = .17).The occurrence rate of 44% in this study was higher than expected and is the first to provide this information in the elderly patients on this fracture. It is important that a high index of suspicion be maintained for the Hoffa fracture in all distal femur fractures, regardless of age or mechanism of injury.

SUBMITTER: Hill BW

PROVIDER: S-EPMC5755847 | biostudies-other | 2017 Dec

REPOSITORIES: biostudies-other

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Hoffa Fragments in the Geriatric Distal Femur Fracture: Myth or Reality?

Hill Brian W BW Cannada Lisa K LK

Geriatric orthopaedic surgery & rehabilitation 20171214 4

<h4>Background</h4>Previous research reported the frequency of coronal plane (Hoffa) fractures in high-energy supracondylar femur fractures in a relatively young population. It is the purpose of this study to identify the frequency of coronal plane fractures seen in elderly patients.<h4>Methods</h4>All patients over the age of 18 years treated for supracondylar femur fractures at 2 level I trauma centers were reviewed over a 4-year period. The patients were stratified (≥60 years and <60 years) a ...[more]

PMID: 29318088

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Project description:OBJECTIVES:This feasibility study and process evaluation assessed the likely success of a definitive trial of intramedullary fixation with locked retrograde nails versus extramedullary fixation with fixed angle plates for fractures of the distal femur. DESIGN & SETTING:A multicentre, parallel, two-arm, randomised controlled feasibility study with an embedded process evaluation was conducted at seven NHS hospitals in England. Treatment was randomly allocated in 1:1 ratio, stratified by centre and chronic cognitive impairment. Participants, but not surgeons or research staff, were blinded to the allocation. PARTICIPANTS:Patients 18 years and older with a fracture of the distal femur, who their surgeon believed would benefit from internal fixation, were eligible to take part.Participants were allocated to receive either a retrograde intramedullary nail or an anatomical locking plate. OUTCOMES:The primary outcomes for this feasibility study were the recruitment rate and completion rate of the EQ-5D-5L at 4?months post-randomisation. Baseline characteristics, disability rating index, quality of life scores, measurements of social support and self-efficacy, resource use and radiographic assessments were also collected. The views of patients and staff were collected during interviews. RESULTS:Recruitment and data completion were lower than expected. 23 of 82 eligible patients were recruited (nail, 11; plate, 12). The recruitment rate was estimated as 0.42 (95% CI 0.27 to 0.62) participants per centre-month. Data completeness of the EQ-5D-5L at 4?months was 61 per cent (95%?CI 43% to 83%). The process evaluation demonstrated that the main barriers to recruitment were variation in treatment pathways across centres, lack of surgeon equipoise and confidence in using both interventions and newly formed research cultures that lacked cohesion. CONCLUSIONS:A modified trial design, with embedded recruitment support intervention, comparing functional outcome in cognitively intact adults who have sustained a fragility fracture of the distal femur is feasible. ETHICS APPROVAL:The Wales Research Ethics Committee 5 approved the study (ref: 16/WA/0225). TRIAL REGISTRATION NUMBER:ISRCTN92089567; Pre-results.

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Hoffa Fragments in the Geriatric Distal Femur Fracture: Myth or Reality?

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Hoffa Fragments in the Geriatric Distal Femur Fracture: Myth or Reality?

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