粉砕のある外側型Hoffa骨折に対し，脛骨粗面骨切りを併用して骨接合術を施行した1例

Tibial Tubercle Osteotomy for the Treatment of a Comminuted Lateral Hoffa Fracture. Case Report

　Hoffa骨折は比較的稀な関節内骨折であり，解剖学的な整復と安定した内固定が必須である．症例は65歳の男性で左大腿骨外側後顆に第3骨片を有する粉砕骨折を認め，骨片は大きく近位後方へ転位し，展開や整復固定に難渋することが予想された．今回，外側傍膝蓋アプローチに脛骨粗面骨切りを併用することで，半月板や靱帯を温存したまま，広い術野が確保でき，良好な整復，内固定が得られた．その結果，術後早期に関節可動域訓練を開始でき，術後4カ月で膝関節痛の訴えなく，膝屈曲可動域150°と良好な膝関節機能を得ることができた．

　Because Hoffa fractures are intra-articular fractures, anatomical reduction and rigid fixation are essential.　A 65-year-old man was diagnosed with a comminuted fracture of the left posterior femoral condyle with displacement of fragments in the proximal-posterior direction.　We performed a lateral parapatellar arthrotomy and tibial tubercle osteotomy, which enabled wide visualization of the surgical field without lateral meniscectomy or ligament resection, and satisfactory reduction and internal fixation were achieved.　Because the patient was able to start early knee motion exercises, and satisfactory function with no postoperative complaints was achieved.