Hoffa Fracture(Bagaria Classification, Diagnosis and Management) PPT
- 1. Medica Lab is NABL accredited
- 2. Medica Lab is NABL accredited HOFFA’S FRACTURE DR.A.SINGH MBBS, D’ORTHO, DNB Medica Superspecialty Hospital Kolkata(West Bengal),India
- 3. Medica Lab is NABL accredited SYNOPSIS • Definition • Mechanism • Radiology • Management • BAGARIA classification system for Hoffa’s Fracture
- 4. Medica Lab is NABL accredited ALBERT HOFFA (31 March 1859 – 31 December 1907) German Surgeon, Orthopedist and Physiotherapist Born in Richmond, Cape of Good Hope Others: Remembered for introducing an operation for congenital hip dislocation (1890)
- 5. Medica Lab is NABL accredited Definition Coronal fracture of the distal femur - intra articular - usually the only attachment is the posterior capsule.
- 6. Medica Lab is NABL accredited
- 7. Medica Lab is NABL accredited Mechanism of Injury • Shearing force on the posterior condyle • Axial Load with knee flexed >= 90 -> tangential force pattern • Typically a motor bike accident in young patient • Subject to shear force in both sagittal and coronal plane -> Intrinsically unstable
- 8. Medica Lab is NABL accredited Clinical Examination • Effusion ++ • Varus/Valgus Instability +/- maybe subtle • Always check for DNVD
- 9. Medica Lab is NABL accredited X Rays • On AP Fore shortened Fracture condyle may lead to appearance of varus or valgus mal-alignment. • On true lat the femoral condyles are not superimposed. • Be wary to misinterpret those as poor X ray. • Oblique view may be useful but when in doubt CT is preferred.
- 10. Medica Lab is NABL accredited
- 11. Medica Lab is NABL accredited
- 12. Medica Lab is NABL accredited CT scan
- 13. Medica Lab is NABL accredited 3 D Recon
- 14. Medica Lab is NABL accredited Management • Hoffa Fracture effectively separates Patellofemoral joint from the Tibiofemoral joint. • Knee movements particularly weight bearing result in high Shear forced along the fracture line, making non operative management unpredictable and adequate stabilization challenging.
- 15. Medica Lab is NABL accredited Principle of treatment • Atraumatic • Anatomical Reduction • Secure Fixation • Early mobilisation & Functional Activity
- 16. Medica Lab is NABL accredited Planning • Approach • Reduction Fixation • Post op
- 17. Medica Lab is NABL accredited Approach • Lateral Para pateallar • Medial Parapatellar • Medial Approach • Posterior
- 18. Medica Lab is NABL accredited Medial Para patellar
- 19. Medica Lab is NABL accredited Lateral Para patellar
- 20. Medica Lab is NABL accredited Medial approach
- 21. Medica Lab is NABL accredited Posterior Approach • When the fragment is too small to be fixed from anterior. • Prone position
- 22. Medica Lab is NABL accredited Posterior Approach
- 23. Medica Lab is NABL accredited Steps • Inspect the Joint • Visualise the fracture line • Clean it - use a spreader • Anatomically reduce and hold • Initiate drilling at Patellofemoral Joint. • Perpendicular to Fracture
- 24. Medica Lab is NABL accredited Reduction • Bone Spreader - clear • Periosteal Elevator • Reduction clamp • Joystick technique
- 25. Medica Lab is NABL accredited Insert Guide Wires
- 26. Medica Lab is NABL accredited Counter Sink & Screw placement
- 27. Medica Lab is NABL accredited Fixation • At least two screws - prevent rotation and achieve compression • Implants not to violate the articular surface • Choice of implant: 3.5/4.5 cortical compression vs CC Vs Headless BeckerPL,StafordPR,GouletR,etal. Comparative analysis for the fixation of coronal distal intraarticular femur fractures. Presented at the 67th annual meeting of the American Academy of Orthopaedic Surgeons, March 15–19, 2000.
- 28. Medica Lab is NABL accredited Fixation
- 29. Medica Lab is NABL accredited Post Op X Rays
- 30. Medica Lab is NABL accredited Complications • Loss of Reduction • Malunion • Neuro vascular damage • AVN?
- 31. Medica Lab is NABL accredited Subsequent Re-displacement
- 32. Medica Lab is NABL accredited Malunions
- 33. Medica Lab is NABL accredited Special Conditions • Bilateral • Unilateral Bicondylar • Associated Supracondylar fracture • Malunited • Arthritic Knees
- 34. Medica Lab is NABL accredited Bicondylar
- 35. Medica Lab is NABL accredited Plates as washers
- 36. Medica Lab is NABL accredited On the Horizon • Arthroscopically assisted surgery • Rapid Prototyping • Bioabsorbable Implants
- 37. Medica Lab is NABL accredited What more do we have ? • • Developing a new classification system: “Bagaria Classification” for Hoffa’s Fracture • Helps to Decide: 1. When to approach anterior and when posterior? 2. When to put screws and when to plate? •
- 38. Medica Lab is NABL accredited Bagaria Classification • • • • Grade 1: Fragment > 2.5 cm on CT axial section at the level of medial epicondyle Grade 2: Fragment < 2.5 cm on CT axial section at the level of medial epicondyle Grade 3: Communition present at the fracture site a) > 2.5 b) < 2.5 Grade 4: Presence of a sagittal fracture line in addition to coronal fracture.
- 39. Medica Lab is NABL accredited Management as per Bagaria Classification of Hoffa Fracture • • • • Grade 1: Two parallel screw anterior to posterior (countersunk or headless) Grade 2: Two parallel screw posterior to anterior (countersunk or headless) Grade 3 a & b: Consider buttress plate/ parallel screws. Grade 4: Anti glide plate
- 40. Medica Lab is NABL accredited Take Home Message • High index suspicion • Operative almost always • Low tech standard technique • AO Principle, Articular cartilage, 2 screws
- 41. Medica Lab is NABL accredited THANK YOU