Twenty-seven-year nonunion of a Hoffa fracture in a 46-year-old patient

Abstract

A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion of a Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion of a Hoffa fracture have been documented in the literature to date, including two children and one adult. This article presents a case of an adult who had nonunion of a Hoffa fracture for 27 years and was treated by open reduction and internal fixation, and the varus deformity corrected with xenogenous bone graft. An excellent result has been achieved to date. This unusual case reminds us that we cannot neglect the possibility of nonunion of a cancellous bone fracture, especially the Hoffa fractures of the medial femoral condyle if they are treated nonoperatively. It also demonstrates that internal fixation with bone graft is effective, even for the 27-year Hoffa fracture.

Isolated Hoffa Fracture - An Unusual and Commonly Forgotten Fracture

“…Fractures of the medial and lateral condyle tend to heal with a varus and valgus deformity, respectively [1,2]. The Hoffa fracture of the lateral femoral condyle is more common than the medial side -rarely the patient present with bicondylar fracture [5,7,8].…”

“…Often missed on plain radiographs but easily found on a CT scan, helping the preoperative planning [1,[4][5][6][7][8]. Up to 25-30% of coronal plane fractures can be missed on plain radiographs [5,7].…”

“…It is an intraarticular fracture of the posterior aspect of the femoral condyle in coronal plane, resulting from high-energy traumas -motor vehicle accidents (most common) or a fall from a height [1,4,6]. Inherently unstable, due to bone instability as well as the pull of the gastrocnemius and popliteus [1,5].…”

“…Hoffa fractures are known as coronal fractures of the femoral condyle and are rare injuries -account for less than 1% of distal femur fractures [1][2][3][4]. The association of Hoffa fracture and proximal tibial fractures is even rarer [5].…”

“…The exact mechanism of this injury is unknown [1,5,6], but it has been postulated that the mechanism of injury is axial compression to the knee with transmission of the ground reaction force through the tibial plateau to the femoral condyles -in a flexed position the posterior portion of the lateral condyle is the leading part of the knee receiving the impact [3].…”