Bicondylar Hoffa Fracture Successfully Treated with Headless Compression Screws

Lee, Sang Yang; Niikura, Takahiro; Igarashi, Takashi; Sakai, Yoshitada; Kuroda, Ryosuke; Kurosaka, Masahiro

doi:10.1155/2014/139897

Cited by 14 publications

(16 citation statements)

References 19 publications

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“…The specific mechanism of a Hoffa fracture is not well understood. [12,13] Most researchers [2,7,14] currently believe that when the knee is in ≥90° of flexion and emergency braking is performed while driving a car, an axial force in either a varus or valgus direction is transferred from the proximal femur to the femoral condyle. At the same time, forces on the distal tibia are transferred to the tibial plateau, resulting in great shear stress between the femoral condyle and the tibial plateau.…”

Section: Injury Mechanismmentioning

confidence: 99%

“…For bicondylar Hoffa fractures, it is necessary to simultaneously expose both condyles [71] to allow proper reduction. Lee et al [13] reported that Gerdy osteotomy combined with an anterior lateral parapatellar approach provides appropriate exposure for bicondylar Hoffa fractures. Fixation with an anti-glide plate on the lateral condyle and tibial osteotomy with two 4.5-mm screws is ideal.…”

Section: Treatmentmentioning

confidence: 99%

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Hoffa fracture of the femoral condyle

et al. 2019

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Background: Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. Methods: We searched Medline, Embase, Cochrane Library, Google Scholar, China National Knowledge Infrastructure, and China Biology Medicine disc, using the terms “Hoffa fracture” and “coronal fracture of femoral condyle.” Results: One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Radiography can reveal fracture lines. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. Open reduction and internal fixation are preferred. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. For bicondylar fractures, a median parapatellar incision can be used. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. Conclusion: Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures.

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Section: Injury Mechanismmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Hoffa fracture of the femoral condyle

et al. 2019

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“…Although Hoffa fractures are typically fixed with AP-oriented screws, Jarit et al, showed that fixation with posteroanteriorly-(PA-) oriented lag screws was biomechanically superior to AP oriented lag screws when subjected to vertical loads. 4 The standard method of fixing these fractures is using cannulated screws in compression mode. However as these are shear fractures, the parallel screw configuration sometimes leads to fixation failure.…”

Section: Case Reportmentioning

confidence: 99%

“…One advantage of using these screws is that compression along the entire length of the screw can be achieved, possibly resulting in improved stability compared with a conventional lag screw. 4…”

Section: Case Reportmentioning

confidence: 99%

The management of intra-articular lateral femoral condyle (Hoffa) fracture of the knee using arthroscopy-assisted fixation: a case report

Aryana¹,

Wibowo²

2018

Int J Res Med Sci

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A Hoffa fracture is a type of supracondylar distal femoral fracture with fracture line located in the coronal plane. It is a rare injury consisting of tangential (coronal shear) fracture of distal femoral condyles. Unicondylar knee fractures are rare and present some diagnostic difficulties due to poor visibility on standard X-ray and are especially harder to identify in non-displaced fracture. A fifty-four-year-old male presented to our emergency room with a chief complaint of pain over his right knee that started 10 months prior. He previously was involved in a motor vehicle accident and underwent open reduction and internal fixation with plate and screws. Physical examination revealed swelling and tenderness over the right knee with limited range of motion. Plain X-ray showed union of tibia plateau fracture with plate and screws and no evidence of distal femoral fracture. A magnetic resonance imaging of the right knee was performed and revealed an intraarticular lateral condyle femur fracture with transverse configuration that was previously missed on plain X-ray. Arthroscopy-assisted reduction and internal fixation using antero-posterior and postero-anterior oriented screws were performed and good reduction was achieved. Diagnosis of this type of fracture is challenging and require some experience. Awareness of such entity and strong clinical suspicion are essential for diagnosis because most of the time the standard X-rays may appear normal. Arthroscopy-assisted fracture fixation using antero-posterior and postero-anterior oriented screws for Hoffa fracture offers many advantages and allows for early mobilization postoperatively without any loss of reduction.

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“…Although the most common mechanism of Hoffa fracture injury is high energy trauma, but the specific mechanism of injury is still unknown. Lewis et al, suggested that axial load to the femoral condyle when the knee is flexed to >90° produces posterior tangential fractures [ 5 ]. There are some difficulties in diagnosis of unicondylar Hoffa fractures because of its poor visibility on standard X-rays especially in non-displaced fractures [ 6 ], so they may be missed.…”

Section: Introductionmentioning

confidence: 99%