Hoffa Nonunion, Two Cases Treated with Headless Compression Screws

Abstract

A coronal fracture of the distal femoral condyle is a rare entity and a nonunion even more so. The coronal fractures, also known as Hoffa fracture, more often involve the lateral than the medial condyle. Open reduction and internal fixation are the primary treatment of choice. We describe two cases of nonunion of a Hoffa fracture (one medial and one lateral). Although the nonunion fragment was not attached to any soft tissues in both cases the fragment was noted to be vital both clinically and histologically. After operative treatment, consisting of debridement, compression with use of headless screws, and liberal use of bone graft both nonunions healed. At latest follow-up, both patients had excellent function and reported no or minimal pain.

Bicondylar Hoffa Fracture Successfully Treated with Headless Compression Screws

“…This is the first report describing the use of such screws for the treatment of a bicondylar Hoffa fracture. 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 [21]. …”

The Hoffa Fracture: Review

“…Для застарелых переломов мыщелков бедра M.P. Somford с соавторами предложили варианты внутренней фиксации с использованием компрессионных винтов Герберта диаметром 5,0 и 6,5 мм с костным аутотрансплантатом из гребня подвздошной кости, при этом дополнительно должна быть установлена нейтрализующая пластина [35].…”

Hoffa fracture of the femoral condyle

“…[64] Open reduction and internal fixation is the 1st choice for the treatment of displaced Hoffa fractures, and it is also suitable for the treatment of nondisplaced Hoffa fractures. The knee joint is placed in flexion during surgery, [65,66] placing the joint capsule and gastrocnemius in a relaxed state, which reduces the traction on the fracture and is conducive to fracture repair. The appropriate surgical plan is chosen based on the location of the Hoffa fracture, characteristics of the fracture line, fracture severity, and associated injuries.…”

“…Headless compression screws are self-compressing and can be positioned beneath the outer cortex resulting in significantly greater axial compression, a higher load limit, and increased fracture stability. [65,67] Moreover, headless compression screws can prevent soft tissue irritation and do not need an additional countersinking procedure. [55] Onay et al [79] performed a long-term follow-up study of Hoffa fracture patients treated with screws and observed that the screws provided sufficient biomechanical stability until the fractures were healed.…”

“…[55] Onay et al [79] performed a long-term follow-up study of Hoffa fracture patients treated with screws and observed that the screws provided sufficient biomechanical stability until the fractures were healed. Somford et al [65] showed that the repair strength of absorbable screw fixation is weak, knee joint activity produces greater shear stress, and there is a risk of screw breakage; thus, careful selection of the surgical plan is recommended.…”