Coronal plane fractures of the posterior femoral condyle, also known as Hoffa fractures, are rare. Lateral fractures are three times more common than medial fractures, although the reason for this is not clear. The exact mechanism of injury is likely to be a vertical shear force on the posterior femoral condyle with varying degrees of knee flexion. These fractures are commonly associated with high-energy trauma and are a diagnostic and surgical challenge. Hoffa fractures are often associated with inter- or supracondylar distal femoral fractures and CT scans are useful in delineating the coronal shear component, which can easily be missed. There are few recommendations in the literature regarding the surgical approach and methods of fixation that may be used for this injury. Non-operative treatment has been associated with poor outcomes. The goals of treatment are anatomical reduction of the articular surface with rigid, stable fixation to allow early mobilisation in order to restore function. A surgical approach that allows access to the posterior aspect of the femoral condyle is described and the use of postero-anterior lag screws with or without an additional buttress plate for fixation of these difficult fractures.

Cite this article: Bone Joint J 2013;95-B:1165–71.

Purpose

There are concerns with regard to the physiological effects of reamed intramedullary femoral fracture stabilisation in patients who have received a pulmonary injury. This large animal study used invasive monitoring techniques to obtain sensitive cardiopulmonary measurements and compared the responses to Early Total Care (reamed intramedullary femoral fracture fixation) to Damage Control Orthopaedics (external fixation), after the induction of acute lung injury. We hypothesised a greater cardiopulmonary response to intramedullary fracture fixation.

Purpose

Antibiotic prophylaxis plays an important role in minimizing surgical site infections as well as other nosocomial peri-operative infections in orthopaedic trauma patients. Pre-operative prophylaxis has been shown to be efficacious, but the role and duration of post-operative prophylaxis remains controversial. The goal of this study was to assess whether patients receive their antibiotic prophylaxis as prescribed. What dose and duration of antibiotics are typically ordered, what patients actually receive, and factors causing the ordered antibiotic regime to be altered were also investigated. This study did not investigate infection rates or the efficacy of various antibiotic prophylactic regimes.

We found the ABG cementless hip has excessive acetabular wear and premature failure due to osteolysis.

In 60 patients implanted at mean age 56 years, 66 hips (mean follow up 48 months), 7 were revised and 7 have severe acetabular osteolysis. In some this is entirely asymptomatic. There was significant association with osteolysis, length of follow up and wear but no correlation between wear and acetabular component position, age, liner thickness, and use of ceramic or CoCr heads.

We recommend regular lifelong radiological review of these hips and suspension of use of this prosthesis until a wider review is undertaken.

This study was designed to emphasise the need for strict rotational alignment whilst performing a posterior sloping tibial resection during primary TKR.

The normal posterior inclination of the bony tibia in the sagittal plane is around 10 degrees. The effect of the menisci reduces this to around 3 degrees. This reduces shear stress during flexion when compressive stress increases.

In TKR it has been shown that tibial components inserted with zero posterior slope (ie. perpendicular in the sagittal plane to long axis of tibia) have an increased incidence of anterior subsidence. This has been shown to be due to the relative weakness of the anterior tibial bone. It is also known that this weakness increases with further resection. Therefore, most knee arthroplasty systems involve a posterior sloping tibial resection to minimize anterior bone loss. This resection, normally in the order of 7 degrees, needs to be made strictly in the AP plane. If a rotational error is introduced, the result will be to remove more bone from one plateau than the other and effectively produce a valgus or varus deformity. If the long axis alignment of the jig is also inaccurate, this will compound the error.

The authors, using a series of sawbones calculated the resultant varus/valgus angulation produced by different degrees of rotational malalignment using posterior sloped cutting blocks of 3 and 7 degrees.

We plan to confirm these findings by using a 3 D CT reconstruction of the human proximal tibia and computer software to simulate the cuts. We have shown that a rotational error of 30 degrees with a 7 degree cutting block will produce an angulation of up to 3 degrees measured in the coronal plane. Whilst not large in itself, this potential error should be highlighted, as a contributive factor in tibial component malalignment.