Discussion on internal fixation of Hoffa fractures / 中国骨伤

Hoffa fracture is an unstable intra-articular fracture with significant redisplacement tendency. It is easy to be missed diagnosis when accompanied by distal intercondylar or supracondylar fracture of femur. CT scan is the gold standard for the diagnosis of Hoffa fracture. The treatment principles are anatomic reduction of the articular surface, reliable internal fixation, and early functional activity. At present, the main treatment is arthroscopic screw fixation. During screw fixation, the tail cap of screw should be buried, resulting in non-healing iatrogenic injury of articular cartilage. In the early postoperative functional activity of knee joint, fracture block was repeatedly subjected to backward and upward shear force under the action of the tibial plateau, which is the main reason for the failure of internal fixation. Plate assisted screw fixation could increase local mechanical stability, but it still cannot avoid the defects of iatrogenic cartilage injury. At the same time, plate molding is required during the operation due to the absence of special anatomical plates, resulting in increased surgical trauma and time-consuming surgery. The ideal fixation method for Hoffa fracture should include:(1) Avoid iatrogenic injury of articular surface cartilage. (2) With the rear anti-shear barrier plate function.(3) The internal fixator is closer to the load interface, so as to obtain greater load and better fixed strength.

Reconstruction of Achilles tendon by transfer of the soleus tendon flap / 中华创伤骨科杂志

Objective To introduce a new surgical method of reconstructing A ch illes tendon by transfer of the soleus tendon flap. Methods The method was desig ned on the basis of the anatomical characteristics of the superficial muscles as sociated with Achilles tendon. It was applied to treat 12 patients with Achilles tendon defects. These patients were followed up for 0.5 to 6 years (average 39 months). Results The curative effect of the method were assessed according to Ar ner-Lindholms evaluation criteria. 9 cases were rated as excellent, 2 fine an d 1 poor, with the total excellent and fine rate being 92%. Conclusions ①Misdi agnosis and improper initial treatment are the major causes of Achilles tendon d efects. ②Systematic training after operation is very important for good curativ e effects. ③The method mentioned above brings about less trauma, less negative effects on blood supply to Achilles tendon, and good healing after operation.