Hoffa's fracture of the medial femoral condyle in a child treated with open reduction and internal fixation: A case report

Alkhalife, Yasser Ibrahim; Alshammari, Abdulmuhsen N; Abouelnaga, Mohamed A

doi:10.1016/j.tcr.2018.01.002

Cited by 10 publications

(10 citation statements)

References 7 publications

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“…Coronal plane fracture of the femoral condyle was named after Hoffa following his detailed research on this fracture in 1904[ 3 ]. Letenneur et al [ 5 ] classified this fracture into three different types.…”

Section: Discussionmentioning

confidence: 99%

“…Computed tomography (CT) is considered efficient in the diagnosis of adult Hoffa's fracture. However, in this case, the thick cartilage of the distal femoral epiphyseal area made it difficult to evaluate the fracture[ 1 , 3 , 4 ]. The area of high signal on magnetic resonance imaging (MRI) also indicated no severe displacement (Figure 2 ).…”

Section: Case Presentationmentioning

confidence: 99%

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Hoffa's fracture in a five-year-old child diagnosed and treated with the assistance of arthroscopy: A case report

Chen¹,

Wang²,

Wang³

et al. 2022

World J Clin Cases

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BACKGROUND Hoffa's fracture is a coronal-oriented fracture of the femoral condyle. It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral femoral condyle. Only a few cases involving Hoffa's fracture of the medial femoral condyle have been reported in patients with undeveloped skeletons. Such a fracture cannot be observed by routine imaging examinations, thus resulting in possible misdiagnosis and further treatment challenges. CASE SUMMARY A 5-year-old boy with Hoffa's fracture of the medial femoral condyle suffered from right knee pain and severe swelling after being hit by a heavy object. The patient was misdiagnosed and initially treated in a local primary healthcare center. No improvement in his right knee’s extension was observed following conservative treatment for 2 wk. The patient was transferred to our hospital, re-diagnosed using arthroscopy, and underwent open reduction and internal fixation. The therapeutic outcome was satisfactory with the screws removed 7 mo after fixation. At the final follow-up of 40 mo, the range of motion in the knee had recovered. There was no varus-valgus instability. CONCLUSION Hoffa's fracture is rarely seen in children aged 5 years, let alone in the medial condyle, and can easily be misdiagnosed due to limited physical and imaging examinations. Suspected Hoffa's fracture in preschool children should be confirmed based on arthroscopic findings. Open reduction and internal fixation should be performed to protect the articular surface and prevent long-term complications.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Hoffa's fracture in a five-year-old child diagnosed and treated with the assistance of arthroscopy: A case report

Chen¹,

Wang²,

Wang³

et al. 2022

World J Clin Cases

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“…Bicondylar Hoffa fracture typically results from direct trauma combined with axial loading with knee in flexion 5 . Isolated Hoffa's fracture of femoral condyle was described for the first time by Bali et al 6 Alkhalife et al 7 have reported that paediatric Hoffa's fracture can be easily missed and has recommended open anatomic reduction to avoid long term complications. Salunke et al 8 .…”

Section: Discussionmentioning

confidence: 99%

Paediatric conjoint bicondylar Hoffa fracture with patellar tendon injury: An unusual pattern of injury

Julfiqar

Huda

Pant

2019

Chinese Journal of Traumatology

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Epiphyseal injuries of distal femur are rare with an incidence of 1%–6% among all physeal injuries. Prompt diagnosis and appropriate surgical treatment is crucial to achieve satisfactory functional outcomes. A conjoint bicondylar coronal split (Hoffa) fracture with complete transaction of ipsilateral patellar tendon has been reported in a 12 year old child. The injury was managed by open reduction and internal fixation and bone to tendon repair. This case emphasizes the need of accurate intraepiphyseal fixation for the management of these fractures in skeletally immature patients.

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“…Therefore, advanced imaging utilities could be of a great value in diagnosis of these fractures especially when there is a suspicion of abnormality at standard x ray films. According to our knowledge seven cases were reported in the literatures discussing Hoffa fractures in skeletally immature patients until last search at 30 august 2019 ( Table 1) [4][5][6][7][8][9][10] . Five of these seven cases were fresh fractures and early managed operatively with different approaches and different techniques and the result were satisfactory [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…According to our knowledge seven cases were reported in the literatures discussing Hoffa fractures in skeletally immature patients until last search at 30 august 2019 ( Table 1) [4][5][6][7][8][9][10] . Five of these seven cases were fresh fractures and early managed operatively with different approaches and different techniques and the result were satisfactory [4][5][6][7][8]. However, only two cases were described in the literatures as a missed Hoffa fracture in an eight year old girl and twelve year old boy went to a nonunion which managed operatively and fixed with cannulated screws and the result were satisfactory in the 1st case the child has virtually full range of motion of the knee and no evidence of growth disturbance, also in the second case radiographic union was observed after 3 months, and after 2 years of follow-up, the child had excellent functional outcome [9,10].…”

Section: Discussionmentioning

confidence: 99%

Missed Hoffa Fracture in Skeletally Immature Patient Complicated by Non-union Pseudoarthrosis: Case Report and Review of Literature

Elazab¹

2019

OROAJ

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Hoffa fractures are uncommon clinical entity typically seen in adults after high-energy trauma, and commonly missed. Moreover, it's extremely rare in children and young adolescents. According to our knowledge only 7 cases were reported in the literature with coronal fracture of the femoral condyle in children and young adolescents until the last search in 30 August 2019. Five of these seven cases discussed fresh fractures and other two cases discussed a missed Hoffa fractures complicated with non-union. In this study we present another case of missed coronal fracture of the lateral femoral condyle that subsequently went on to non-union and pseudoarthrosis in a 12 years old boy. The patient presented 4 months after motor vehicle accident with symptoms of right knee pain, snapping and instability. Radiological evaluation revealed a non-united lateral Hoffa fracture. The non-united fragment involved about two third of the lateral femoral condyle. operative intervention was our decision, diagnostic arthroscopy was done 1st then open arthrotomy using anterolateral approach for excision of pseudoarthrosis, open reduction and internal fixation of the fracture. Six months postoperative outcome was satisfactory, with full range of motion and return to sport. .

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Hoffa's fracture of the medial femoral condyle in a child treated with open reduction and internal fixation: A case report

Cited by 10 publications

References 7 publications

Hoffa's fracture in a five-year-old child diagnosed and treated with the assistance of arthroscopy: A case report

Hoffa's fracture in a five-year-old child diagnosed and treated with the assistance of arthroscopy: A case report

Paediatric conjoint bicondylar Hoffa fracture with patellar tendon injury: An unusual pattern of injury

Missed Hoffa Fracture in Skeletally Immature Patient Complicated by Non-union Pseudoarthrosis: Case Report and Review of Literature

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