Main Article Content

Abstract

BACKGROUND


Hoffa fractures are intra-articular femoral condyle fractures in the coronal plane. These are very uncommon injuries. The purpose of this study was radiologic and functional outcome assessment of surgically managed Hoffa fractures with headless compression screws.


METHODS


We prospectively studied 11 patients with isolated Hoffa fractures who were treated with open reduction and internal fixation using two or more headless compression screws. Antiglide plate was used only in one case. We used the midline parapatellar approach for all cases. All patients had gone through aggressive physiotherapy after the operation. All patients were evaluated radiologically and functionally on a regular interval. The functional outcome was recorded in terms of Lysholm score, Knee society score (KSS), Range of motion (ROM) and VAS score.


RESULTS


All fractures united radiologically with an average time of 3.3 months with no evidence of subsequent fixation failure. The mean Lysholm score and KSS at final follow-up were 88.6±7.1 and 86±7.6 respectively. The mean knee range of motion was from 0˚ to 120.5˚ ± 9.3˚. At the final follow-up, the mean VAS score dropped significantly to 0.63±0.8.


CONCLUSIONS


Operative management of Hoffa fractures with at least two headless compression screws can yield satisfactory functional and radiologic outcomes. Stable fixation and timely physiotherapy are the keys to success.

Keywords

Hoffa, Coronal, Fixation, Functional Outcome

Article Details

How to Cite
Rajesh Kar, Gaurab Chatterjee, & Atanu Chatterjee. (2022). Coronally Oriented Intra - Articular Distal Femur Hoffa Fracture - How We Deal with It. Journal of Evolution of Medical and Dental Sciences, 11(8), 738–743. https://doi.org/10.14260/jemds.v11i8.166

References

  1. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Operativetreatment of unilateral bicondylar Hoffa fractures. J Orthop Trauma 2004;18(2):119-22.
  2. Hoffa A. Lehrbruch der Frakturen und Luxationen. 4th edn. Stuttgart, Germany: Ferdinand Enke 1904.
  3. Kumar R, Malhotra R. The Hoffa fracture: three case reports. J Orthop Surg (Hong Kong) 2001;9(2):47-51.
  4. Arastu MH, Kokke MC, Duffy PJ, et al. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management. Bone Joint J 2013;95-B(9):1165-71.
  5. Zeebregts CJ, Zimmerman KW, ten Duis HJ. Operative treatment of a unilateral bicondylar fracture of the femur. Acta Chir Belg 2000;100(3):104-6.
  6. White EA, Matcuk GR, Schein A, et al. Coronal plane fracture of the femoral condyles: anatomy, injury patterns, and approach to management of the Hoffa fragment. Skeletal Radiol 2015;44(1):37-43.
  7. Cheng PL, Choi SH, Hsu YC. Hoffa fracture: should precautions be taken during fixation and rehabilitation? Hong Kong Med J 2009;15(5):385-7.
  8. Mootha AK, Majety P, Kumar V. Undiagnosed Hoffa fracture of medial femoral condyle presenting as chronic pain in a post-polio limb. Chin J Traumatol 2014;17(3):180-2.
  9. Goel A, Sabat D, Agrawal P. Arthroscopic-assisted fixation of Hoffa fracture: a case report and description of technique. J Clin Orthop Trauma 2016;7(1):61-5.
  10. Lee SY, Niikura T, Iwakura T, et al. Bicondylar hoffa fracture successfully treated with headless compression screws. Case Rep Orthop 2014;2014:139897.
  11. Flanagin BA, Cruz AI, Medvecky MJ. Hoffa fracture in a 14-year-old. Orthopedics 2011;34(2):138.
  12. Cheng S, Zaidi SF, Linnau KF. ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. Emerg Radiol 2015;22(3):337-8.
  13. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. Acta Orthop Traumatol Turc 2014;48(4):383-7.
  14. Sharath RK, Gadi D, Grover A, et al. Operative treatment of isolated bicondylar Hoffa fracture with a modified Swashbuckler approach. Arch Trauma Res 2015;4(4):e25313.
  15. Holmes SM, Bomback D, Baumgaertner MR. Coronal fractures of the femoral condyle: a brief report of five cases. J Orthop Trauma 2004;18(5):316-9.
  16. Lewis SL, Pozo JL, Muirhead-Allwood WF. Coronal fractures of the lateral femoral condyle. J Bone Joint Surg Br 1989;71(1):118-20.
  17. Ostermann PA, Neumann K, Ekkernkamp A, et al. Long term results of unicondylar fractures of the femur. J Orthop Trauma 1994;8(2):142-6.
  18. Ozturk A, Ozkan Y, Ozdemir RM. Nonunion of a Hoffa fracture in an adult. Chir Organi Mov 2009;93(3):183-5.
  19. Gavaskar AS, Tummala NC, Krishnamurthy M. Operative management of Hoffa fracturese--a prospective review of 18 patients. Injury 2011;42(12):1495-8.
  20. Trikha V, Das S, Gaba S, et al. Analysis of functional outcome of Hoffa fractures: a retrospective review of 32 patients. J Orthop Surg (Hong Kong) 2017;25(2):2309499017718928.
  21. Jarit GJ, Kummer FJ, Gibber MJ, et al. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). J Orthop Trauma 2006;20(4):273-6.
  22. Gao M, Tao J, Zhou Z, et al. Surgical treatment and rehabilitation of medial hoffa fractures fixed by locking plate and additional screws: a retrspective cohort study. Int J Surg 2015;19:95-102.
  23. Zura RD, Browne JA. Current concepts in locked plating. J Surg Orthop Adv 2006;15(3):173-6.