Reconstructive osteotomy for a malunited medial Hoffa fracture – A feasible salvage option

Abstract

A 35-year-old male presented with pain and restriction of movements of right knee of 9 months duration. He underwent open reduction and internal fixation for a coronal plane fracture of medial femoral condyle (Hoffa fracture) in another facility 9 months back. Radiological evaluation showed a malunited isolated medial Hoffa fracture. We did an intraarticular osteotomy as a salvage treatment and got a reasonable outcome. This case report analyses the difficulties in the management of this inherently unstable fracture pattern and the technique of intraarticular osteotomy.

Corrective Intra-Articular Osteotomy Using a 3D-Printed Model and Induced Membrane Technique for AO/OTA C3 Distal Femur Fracture with Articular Malunion and Metaphyseal Nonunion

“…Corrective osteotomy after a malunited intra-articular fracture is reported in other parts such as the distal radius and tibial plateau, which led to satisfactory results [6,7]. There are two case reports of corrective osteotomy for the malunited Hoffa fracture [3,4]. They have concluded that the malunited fracture can lead to the restriction of the range of movement, as well as pain and subsequent osteoarthritis.…”

“…For the malunion of fractures, salvage corrective osteotomy for extra-articular malunion is often reported, and intra-articular osteotomy for malunited Hoffa fracture (AO/OTA classification 33-B3) is also described [2][3][4]. However, there is no report of osteotomy in multiple segmental malunion of the distal femoral articular fracture.…”

Corrective Osteotomy for Coronal Plane Malunion of the Medial Femoral Condyle

“…One of the most important differences between the medial and lateral femoral condyles is that the intraosseous blood supply to the medial femoral condyle has limited vascularity compared with that of the lateral femoral condyle [ 4 - 5 ]. The arterial supply of the medial femoral condyle is primarily contributed by the superior medial genicular artery, but the lateral femoral condyle is supplied by both superior and inferior lateral genicular arteries [ 5 ].…”

“…The lateral condyle is injured three times more frequently than the medial one. The prepotency of the lateral condyle can be attributed to physiological valgus at the knee [ 3 - 4 ]. Generally, Hoffa fractures are seen as a result of a high-velocity, high-energy trauma [ 5 ].…”

“…Corrective osteotomy for medial femoral condyle malunion in the coronal plane is an acceptable salvage option, as it can reduce pain, improve the range of motion of the knee, and prevent joint damage and post-traumatic arthritis in the future [ 4 ].…”