Hoffa fracture of the femoral condyle

Abstract

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.

Exchange Nailing as Revision Surgery for Post-operative Non-union of Atypical Femoral Fractures: A Case Report and Treatment Strategy

“…The injury mechanism of Hoffa fracture ranges from low energy trauma to high energy trauma; however, it is not well understood specifically [ 17 ]. Road traffic accident is the most common cause of this type of fracture in children as likewise in adults.…”

“…However, in our case, the child had a Hoffa fracture involving right medial femoral condyle and undisplaced vertical fracture of right patella due to sustained high-energy trauma (fall from height) without any significant open injury in either leg or any other systemic injury. In addition, it can also result as an iatrogenic injury during surgical reconstructive procedures of anterior cruciate ligament and thereby this aspect too requires significant attention of operating team [ 17 ].…”

“…The clinical manifestations locally noted in Hoffa fracture are pain, swelling, change in skin color with or without any skin defect, and limited mobility of the knee joint [ 19 ]. In some patients, positive floating patella test , anterior and posterior drawer test, and medial or lateral stress test were reported positive [ 17 ]. Moreover, it has also been reported that people with Hoffa fracture presents with instability when flexed at 30° but not witnessed in straightened leg while being examined under general anaesthesia [ 20 ].…”

“…First treating physician missed the fracture by only getting one plane radiograph [ 8 ]. Further, it has been noted that high energy trauma causing medial condylar Hoffa fracture is frequently associated with other fractures involving tibia, both the condyles, intercondylare, supracondylare, patella, dislocation of knee, shaft of femur, or pelvis may present with excruciating pain in combination and thereby culminate into the missed diagnosis of Hoffa fracture [ 17 ].…”

“…McDonough et al reported non-union of Hoffa fracture where injury took place 5 years back [ 6 ]. Be that as it may, such injury in a paediatric age group postures uncommon issues because of the nearness of an open physis [ 8 , 17 , 21 ].…”