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

Abstract

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.

Valgus knee deformity due to nonunion of lateral Hoffa fracture: A case report

“…No bone graft was performed in our case; Zhang et al [1] described in their case report the need for cancellous bone graft for bridging of the epiphysis. Both of his cases were Letenneur type-II, whereas our case was Type III.…”

“…Coronal fractures of the femoral condyle, also known as Hoffa fractures, are rare intra-articular injuries. Surgical treatment with open reduction and internal fixation is recommended for Hoffa fractures because conservative treatment is associated with a risk of displacement of the fracture fragment, nonunion, and avascular necrosis [1] . Nonunion of Hoffa fractures is rarer, and most studies on Hoffa fractures are case reports [1] , [2] .…”

“…Surgical treatment with open reduction and internal fixation is recommended for Hoffa fractures because conservative treatment is associated with a risk of displacement of the fracture fragment, nonunion, and avascular necrosis [1] . Nonunion of Hoffa fractures is rarer, and most studies on Hoffa fractures are case reports [1] , [2] . Various case reports have suggested that cases of nonunion of Hoffa fractures should be treated with a debridement and open reduction and internal fixation.…”

“…Various case reports have suggested that cases of nonunion of Hoffa fractures should be treated with a debridement and open reduction and internal fixation. Headless screws, lateral LCP plates, combination of the lateral extra-articular buttress plates, and two cannulated lag screws are often used for the treatment of Hoffa fractures in patients with nonunions [1] , [2] , [3] , [4] . This article presents the case of a 38-year-old man with a valgus knee deformity due to the nonunion of a Hoffa fracture that occurred 11 years ago and was treated with headless screws and LCP plates, resulting in a favorable clinical outcome and lower limb alignment.…”

Hoffa’s fracture in an adolescent treated with an innovative surgical procedure: A case report

“…Direct lateral/medial and posterolateral approaches can expose small Hoffa fragments and employ the more biologically advantageous posterior-anterior direction screws, as well as a plate if necessary, but with a risk of neurovascular injury; lateral/medial parapatellar approaches are suitable for large Hoffa fragments and can expose both the femoral condyles, but small Hoffa fragments are difficult to expose and reduce, and posterior-anterior direction screws are not feasible[ 17 ]. Other studies[ 18 - 21 ] reported the treatment of the nonunion of Hoffa fracture, suggesting bone grafting following debridement and fixation with screws and bone plates, and finally achieved satisfactory results. Currently, there is no optimal surgical approach and fixation method[ 3 ]; hence, the treatment of the different types of Hoffa fractures are mainly determined by the experience and skill of the surgeon.…”