Long Term Follow-up of an Open Bicondylar Hoffa Fracture with a Disrupted Extensor Mechanism: A Case Report

Joseph, Christina Marie; Rama-Prasad, Y S; Boopalan, P.R.J.V.C.; Jepegnanam, Thilak Samuel

doi:10.5704/moj.1907.013

Malays Orthop J

2019

DOI: 10.5704/moj.1907.013

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Long Term Follow-up of an Open Bicondylar Hoffa Fracture with a Disrupted Extensor Mechanism: A Case Report

Christina Marie Joseph

Y S Rama-Prasad²,

P.R.J.V.C. Boopalan

et al.

Abstract: This is the first report of a long-term follow-up of an open bicondylar Hoffa with patella fracture. It is interesting to note the radiological changes of osteoarthritis 15 years after global intra-articular injury of the distal femur. The good clinical outcome is possibly due to the integrity of the knee ligaments and reconstruction of the extensor mechanism in addition to stable anatomical reduction and fixation.

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Cited by 6 publications

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Busch-Hoffa fracture: A systematic review

Rabelo,

Pires,

Las Casas

et al. 2023

Medicine

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Background: Accomplish a thorough review on the existing biomechanical and clinical studies about coronal plane fractures of the distal femur. Methods: We performed an electronic search of PubMed/MEDLINE database from April to June, 2023. The terms for the database search included “Hoffa fractures,” OR “Busch-Hoffa fractures” OR “coronal plane fractures of the distal femur.” Results: The search identified 277 potentially eligible studies. After application of inclusion and exclusion criteria, 113 articles were analyzed in terms of the most important topics related to coronal plane fractures of the distal femur. Conclusion: Lateral coronal plane fractures of the distal femur are more frequent than medial, present a more vertical fracture line, and usually concentrate on the weight bearing zone of the condyle. The Letenneur system is the most used classification method for this fracture pattern. Posterior-to-anterior fixation using isolated lag screws (for osteochondral fragments—Letenneur type 2) or associated with a posterior buttressing plate (when the fracture pattern is amenable for plate fixation—Letenneur types 1 and 3) is biomechanically more efficient than anterior-to-posterior fixation. Anterior-to-posterior fixation using lag screws complemented or not by a plate remains a widely used treatment option due to the surgeons’ familiarity with the anterior approaches and lower risk of iatrogenic neurovascular injuries. There is no consensus in the literature regarding diameter and number of screws for fixation of coronal plane fractures of the distal femur.

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Busch-Hoffa fracture: A systematic review

Rabelo,

Pires,

Las Casas

et al. 2023

Medicine

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Do intra-articular knee injuries detected by preoperative MRI affect the clinical management of extensor mechanism ruptures?

Turner

Akoh

Hetzel

et al. 2021

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives: We sought to determine the prevalence of intra-articular findings at the time of extensor mechanism injury that required subsequent surgical intervention. Design: Retrospective cohort study. Setting: Level 1 academic trauma center. Patients/participants: Sixty-seven knees in 66 nonconsecutive patients (mean age 53.6 years, 95.6% male) with extensor mechanism injury and preoperative magnetic resonance imaging (MRI) before undergoing open primary surgical repair. Main outcome measurements: Patellar or quadriceps tendon rupture, high or low injury energy level, and age above or below 45 years were used to stratify patients. The primary outcome was additional surgery for intra-articular injury. Demographics, comorbidities, mechanism and location of injury, and internal derangements based on MRI findings were also collected. Results: Fifty-one knees (76.1%) had quadriceps tendon injury, 13 knees (19.4%) had patellar tendon injury, and 3 knees (4.6%) had both. Thirty-four knees (50.7%) had intra-articular pathology and 3 (4.5%) required additional surgery, including 1 knee (7.7%) with patellar tendon injury and 2 knees (3.9%) with quadriceps tendon injury. Patellar tendon injuries were more commonly associated with cruciate ligament injury ( P < .01) and occurred in younger patients ( P < .001) than quadriceps tendon injury. Conclusions: 50.7% of cases with extensor mechanism injury had intra-articular pathology but only 4.5% required additional surgery. The results of our study suggest that preoperative MRI is unlikely to be of significant clinical utility in most extensor mechanism injuries but should be considered in cases of patellar tendon rupture in younger patients where the incidence of concomitant cruciate ligament injury is higher. Level of evidence: Diagnostic Level III.

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Surgical Treatment and Rehabilitation for Hoffa Fracture Nonunion: Two Case Reports and a Literature Review

Zhang

Tao

et al. 2020

Orthopaedic Surgery

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Background A coronal fracture of the distal femoral condyle, known as a Hoffa fracture, seldom occurs and is easy to misdiagnose. Surgery treatment, including open anatomic reduction and internal fixation, is the primary method of treatment. However, cases involving nonunion are extremely rare. Case Presentation We reported two cases in a 56‐year‐old female who visited our outpatient clinic with complaints of locking sensation, swelling, and pain, and a 64‐year‐old male patient who need additional care after having undergone surgery for a distal femur fracture. They presented with nonunion ofa Hoffa fracture (Letenneur type II), and these cases of nonunion were resolved surgically with debridement, two cannulated lag screws, a lateral extra‐articular buttress plate, and the liberal use of autologous bone grafts. After surgery, the two patients were allowed to bear partial weight and perform exercises. They were allowed to walk with full weight‐bearing after 3 months. No early complications, such as infection and loss of reduction, were noted after the revision surgery. At the one‐year follow‐up, both patients had excellent function and reported minimal pain, with a Lysholm score of 94. Conclusions Our case reports highlight the importance of the liberal use of autologous bone grafts, which allow stable reconstruction of the affected femoral condyle, thereby restoring joint congruence. A lateral extra‐articular buttress plate in combination with two cannulated lag screws is recommended for nonunion in Hoffa fracture patients, and they need to be closely followed up to detect complications promptly, especially those related to nonunion.

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Long Term Follow-up of an Open Bicondylar Hoffa Fracture with a Disrupted Extensor Mechanism: A Case Report

Cited by 6 publications

References 5 publications

Busch-Hoffa fracture: A systematic review

Busch-Hoffa fracture: A systematic review

Do intra-articular knee injuries detected by preoperative MRI affect the clinical management of extensor mechanism ruptures?

Surgical Treatment and Rehabilitation for Hoffa Fracture Nonunion: Two Case Reports and a Literature Review

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