Application of Ni-Ti Alloy connector for the treatment of comminuted coronal plane supracondylar-condylar femoral fractures: a retrospective review of 21 patients

BMC Musculoskeletal Disorders

Yang Xie¹  Shuogui Xu¹  Chuncai Zhang¹  Yang Tang¹  Xue Zhao¹  Yuntong Zhang¹ 

[1] Department of orthopaedics, Changhai Hospital, Second Military Medical University, No.168, Changhai Street, Shanghai 200433, China

关键词: Femoral fracture;    Coronal plane;    Comminuted;    Treatment;    Shape memory alloy;   

Others  :  1129043
DOI  :  10.1186/1471-2474-14-355

 received in 2013-05-19, accepted in 2013-11-27,  发布年份 2013

【 摘 要 】

Background

Our preliminary retrospective study assessed outcomes after the use of Ni-Ti arched shape-memory connector (ASC) combined with partially threaded cancellous screws (PTCS) to repair coronal plane supracondylar-condylar femoral fractures.

Methods

Twenty-one patients (16 men and 5 women) with a mean age of 34.1 years (range, 28 to 44 years) with coronal plane supracondylar and condylar fractures of the distal femur were included in this study. Each patient underwent open reduction and internal fixation using the ASC and PTCS. Active functional exercises with restricted weight bearing were initiated the first postoperative day. A gradual increase in weight bearing status and range of motion was permitted and subjects progressed to full weight bearing by 8 weeks. Surgical time, blood loss, postoperative knee range of motion, American Knee Society Scores (KSS), and postoperative complications were assessed.

Results

The mean surgical time was 75 mins (range, 45 to 100 mins) and average blood loss was 105 ml (range, 35 to 130 ml). Mean follow-up was 65 months (range, 22 to 90 months). No subjects demonstrated evidence of osteonecrosis or arthritis at the final follow-up. The mean KSS was excellent (≥85) in 8 subjects, good (70-84) in 11 subjects, and fair (60-69) in 2 subjects. The mean active range of motion of knee flexion at final follow-up was 100 degrees (range, 85 to 110 degrees).

Conclusions

ASC combined with PTCS can serve as an effective means for managing comminuted femoral fractures that extend from the condyle to the supracondylar region. However, further prospective comparative studies and biomechanical analyses are needed to evaluate long-term outcomes using these materials.

【 授权许可】

   
2013 Zhang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Hoffa A: Lehrbuch der Frakturen und Luxationen. 4th edition. Stuttgart: Ferdinand Enke-Verlag; 1904:453.
• [2]Vaishya R, Singh AP, Dar IT, et al.: Hoffa fracture with ipsilateral patellar dislocation resulting from household trauma. Can J Surg 2009, 52(1):E3-E4.
• [3]Payne R, Clark D, Wall S: Union after delayed presentation of a Hoffa fracture. Inj Extra 2005, 36(7):289-291.
• [4]Lewis SL, Pozo JL, Muirhead-Allwood WF: Coronal fractures of the lateral femoral condyle. J Bone Joint Surg Br 1989, 71:118-120.
• [5]Butler MS, Brumback RJ, Ellison TS, et al.: Interlocking intramedullary nailing for ipsilateral fractures of the femoral shaft and distal part of the femur. J Bone Joint Surg Am 1991, 73:1492-1502.
• [6]Nork SE, Segina DN, Aflatoon K, et al.: The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. J Bone Joint Surg Am 2005, 87(3):564-569.
• [7]Ostermann PA, Neumann K, Ekkernkamp A, Muhr G: Long term results of unicondylar fractures of the femur. J Orthop Trauma 1994, 8:142-146.
• [8]Ocguder A, Bozkurt M, Kalkan T, et al.: Hoffa fracture, eminentia fracture and posterior cruciate ligament damage: an unusual knee injury. Inj Extra 2008, 39:88-91.
• [9]Ashok SG, Naveen CT, Mukunth K: Operative management of Hoffa fractures—a prospective review of 18 patients. Injury 2011, 42:1495-1498.
• [10]Liu XW, Xu SG, Zhang CC, et al.: Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China. Int Orthop 2010, 34(7):1033-1040.
• [11]Xu SG, Zhang CC, Wu YL, et al.: Swan-like memory compressive connector. J Mater Eng Perform 2011, 20(1):139-142.
• [12]Xu SG, Zhang CC: Design and clinical application of proximal humerus memory connector. J Mater Eng Perform 2011, 20(1):143-146.
• [13]Cao LH, Xu SG, Wu YL, et al.: Treatment of nonunion of scaphoid waist with Ni-Ti shape-memory alloy connector and iliac bone graft. J Mater Eng Perform 2011, 20(4):629-631.
• [14]Su JC, Liu XY, Yu BQ, et al.: Shape memory Ni-Ti alloy swan-like bone connector for treatment of humeral shaft nonunion. Int Orthop 2010, 34(3):369-375.
• [15]Holmes SM, Bomback D, Baumgaertner MR: Coronal fractures of the femoral condyle: a brief report of five cases. J Orthop Trauma 2004, 18:316-319.
• [16]Lewis SL, Pozo JL, Muirhead-Allwood WFG: Coronal fractures of the lateral femoral condyle. J Bone Joint Surg 1989, 71B:118-120.
• [17]Papadopoulos AX, Panagopoulos A, Karageorgos A, et al.: Operative treatment of bilateral bicondylar Hoffa fractures. J Orthop Trauma 2004, 18:119-122.
• [18]Zeebregts CJ, Zimmerman KW, Duis HJ: Operative treatment of a unilateral bicondylar fracture of the femur. Acta Chir Belg 2000, 100:104-166.
• [19]Meyer C, Enns P, Alt V, Pavlidis T, et al.: Difficulties involved in the Hoffa fractures. Unfallchirurg 2004, 107:15-121.
• [20]Liebergall M, Wilber JH, Mosheiff R, et al.: Gerdy’s tubercule osteotomy for the treatment of coronal fractures of the lateral femoral condyle. J Orthop Trauma 2000, 14:214-215.
• [21]Kumar R, Malhotra R: The Hoffa fracture: three case reports. J Orthop Surg 2001, 9(2):47-51.
• [22]Benirschke SK, Swiontkowski MF: Knee. In Orthopaedic trauma protocols. Edited by Hansen STJr, Swintkowski MF. New York: Raven; 1993:291-329.
• [23]Cheng PL, Shoi SH, Hsu YS: Hoffa fracture: should precautions be taken during fixation and rehabilitation? Hong Kong Med J 2009, 15:385-387.
• [24]Mize RD: Surgical management of complex fractures of the distal femur. Clin Orthop 1989, 240:77-86.
• [25]Jarit GJ, Kummer FJ, Gibber MJ, et al.: A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). J Orthop Trauma 2006, 20(4):273-276.
• [26]Borse V, Hahnel J, Cohen A: Hoffa fracture: fixation using headless compression screws. Eur J Trauma Emerg Surg 2010, 36(5):477-479.
• [27]Perren SM: Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002, 84:1093-1110.
• [28]Schatzker J, Tile M: Supracondylar fractures of the femur. In The rationale of operative fracture care. thirdth edition. Edited by Schatzker J, Tile M. Berlin Heidelberg: Springer; 2005:409-439.
• [29]Adam P, Bonnomet F, Ehlinger M: Advantage and limitations of a minimally-invasive approach and early weight bearing in the treatment of tibial shaft fractures with locking plates. Orthop Traumatol Surg Res 2012, 98:564-569.
• [30]Kolb W, Guhlmann H, Windisch C, et al.: Fixation of distal femoral fractures with the less invasive stabilization system: a minimally invasive treatment with locked fixed-angle screws. J Trauma Acute Care Surg 2008, 65(6):1425-1434.
• [31]Zhang CQ, Sun Y, Jin DX, et al.: Reverse LISS plating for intertrochanteric hip fractures in elderly patients. BMC Musculoskelet Disord 2010, 11:166. BioMed Central Full Text
• [32]Fernandes DJ, Peres RV, Mendes AM: Understanding the shape-memory alloys used in orthodontics. ISRN Dent 2011, 2011:132408.
• [33]Levi DS, Kusnezov N, Carman GP: Smart materials applications for pediatric cardiovascular devices. Pediatr Res 2008, 63:552-558.
• [34]Sumner DR, Turner TM, Igloria R, et al.: Functional adaptation and ingrowth of bone vary as a function of hip implant stiffness. J Biomech 1998, 31:909-917.
• [35]Liu XW, Xu SG, Zhang CC, et al.: Mechanical study of posterior wall acetabular fracture fixation using acetabular tridimensional memory alloy-fixation system. Clin Biomech 2010, 25:312-317.