Coronal plane partial articular fractures of the distal femoral condyle

Abstract

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.

Surgical management of complex intra-articular distal femoral and bicondylar Hoffa fracture

“…The standard method of treating Hoffa fractures has been lag screw fixation. 1 There have been reported cases where fixation was performed with buttress plates. 2 In our case, the main difficulty arose from the co-existence of significant fragmentation on the metaphysis of the To overcome this difficulty, we used two buttress plates on the medial and lateral sides, more or less parallel to each other.…”

“…Fractures involving the lateral condyle are more common than medial fractures, while fractures involving both condyles are extremely rare. 1 The treatment of Hoffa's fractures follows the principles of fixation of intraarticular fractures, and requires anatomic reduction and rigid fixation. 1 This is typically achieved with screws orientated from anterior to posterior, due to the ease of approach, visualisation and placement.…”

“…1 The treatment of Hoffa's fractures follows the principles of fixation of intraarticular fractures, and requires anatomic reduction and rigid fixation. 1 This is typically achieved with screws orientated from anterior to posterior, due to the ease of approach, visualisation and placement. Fixation with a buttress plate has also been reported.…”

Arthroscopic Management of a Posterior Femoral Condyle (Hoffa) Fracture: Surgical Technique

“…7 Such treatment is difficult and almost infeasible because of limited access when using the lateral parapatellar exposure 8 dhence the advantage of arthroscopic-assisted reduction and fixation with cannulated screws (Synthes).…”

Fracture of the Lateral Femoral Condyle

“…1 The physical therapist immediately referred the patient to an orthopaedic surgeon, and the fracture was further evaluated with computed tomography (FIGURE 2). 1 The patient was …”