Hoffa fragment associated with a femoral shaft fracture. A case report

Fully arthroscopic treatment of medial Hoffa fracture associated with anterior cruciate ligament tear: case report and surgical technique

A Hoffa fracture is a rare intra-articular injury consisting of a coronal plane fracture of one or both of the distal femoral condyles. Because of the rarity of medial Hoffa fractures, only a few reports have described this injury and its arthroscopic management. In this article, we present a rare case involving a 32-year-old man with a displaced medial Hoffa fracture associated with a proximal anterior cruciate ligament tear. He was treated by a single-stage fully all-inside arthroscopic technique. Arthroscopic-assisted internal fixation ensured fragment stability and enabled us to visualize the fracture reduction, monitor the screw insertion, and reconstruct the anterior cruciate ligament tear at the same time. This technique is a novel but demanding treatment method for medial Hoffa fractures and is particularly useful for properly selected patients with associated intra-articular knee injuries.

Hoffa's Fracture with Associated Injuries Around the Knee Joint: An Approach to a Rare Injury

Fractures of the distal femur typically occur in the axial and sagittal planes. A Hoffa fracture is a coronal plane fracture of the femoral condyle, which accounts for 8.7% to 13% of distal femoral fractures. It is usually associated with other injuries around the knee joint and hence is often missed. We conducted a comprehensive systematic review of papers published in the English language using PubMed, Web of Science, Scopus, and the Cochrane Database, which reported Hoffa's fracture associated with other injuries around the knee joint. We selected 11 eligible papers for final analysis and review. These papers had 12 patients with Hoffa’s fracture, with associated injuries around the knee joint. The associated injuries with Hoffa’s fracture were in the ipsilateral distal femur, proximal tibia fractures, patellar dislocation, patella fracture, and patellar tendon incarceration. The management principles for Hoffa's fracture with associated injuries around the knee joint are: having a high clinical index of suspicion for these injuries, obtaining all trauma series radiographs and computed tomography of the knee, achieving complete articular incongruity, and restoring the functions of the knee joint.

Hoffa fracture associated with tibial shaft fracture and multiple ligament avulsion fractures: A case report

Hoffa fracture combined with tibial shaft fracture and multiple ligament avulsion injuries is extremely rare. Herein, we report a case of medial Hoffa fracture with associated fracture of tibial shaft and avulsion fractures of multiple ligaments secondary to knee dislocation. A 17-year-old female with history of a motorcycle accident was referred to our hospital after knee joint reduction at a regional trauma center. Preoperative radiology revealed a medial Hoffa fracture associated with tibial shaft fracture, inferior pole patellar fracture, fibular head fracture and multiple ligament avulsion fractures including anterior cruciate ligament, posterior cruciate ligament and medial collateral ligament. A less invasive approach via arthroscopy-assisted technique and minimally invasive plate osteosynthesis (MIPO) technique was used for fracture reduction and fixation. Six months postoperatively, the patient had arthrofibrosis and adhesiolysis under arthroscopy was performed. At the last follow-up of 24 months, the patient regained knee full range of motion and returned to pre-injury level of activities. Although minimally invasive techniques were used to speed recovery, the orthopaedic surgeon should still be aware of the possibility of postoperative arthrofibrosis as multiple site fractures may need longer immobilization.

Hoffa fracture accompanied by dissection of the popliteal artery

After a high-energy trauma, a 37-year-old motorcyclist presented to the emergency ward with a Hoffa fracture of the lateral femoral condyle of the right knee. Following admission, the patient developed a pale, cold and pulseless right foot. CT angiography scan showed a 5 cm dissection of the popliteal artery. Emergency arterial reconstruction was performed and the Hoffa fracture was repaired in a second stage. To our knowledge, this is the first report of a patient with a Hoffa fracture accompanied by a popliteal artery dissection.

Hoffa fracture of the femoral condyle: Injury mechanism, classification, diagnosis, and treatment

BACKGROUND

Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries.

METHODS

We searched Medline, Embase, Cochrane Library, Google Scholar, China National Knowledge Infrastructure, and China Biology Medicine disc, using the terms "Hoffa fracture" and "coronal fracture of femoral condyle."

RESULTS

One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Radiography can reveal fracture lines. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. Open reduction and internal fixation are preferred. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. For bicondylar fractures, a median parapatellar incision can be used. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used.

CONCLUSION

Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures.

Relationships between Hoffa fragment size and surgical approach selection: a cadaveric study

INTRODUCTION

Fixation of a small Hoffa fragment requires a selection of the proper surgical approach for reduction and posterior to anterior screws fixation. However, currently there are no guidelines regarding how to select the best approach for small posterior Hoffa fractures.

OBJECTIVES

To compare the size of Hoffa fractures that are appropriate for reduction and fixation with the medial parapatellar approach (MPPA) and those which require the direct medial approach (DMA), and to make a similar comparison between the lateral parapatellar approach (LPPA) and the posterolateral approach (PLA).

MATERIALS AND METHODS

Twenty extremities of fresh cadavers were included. After completion of each approach, the articular surface boundaries were marked and soft tissue was removed. On the medial condyle, an imaginary line was drawn from the most anterior (A) to the most posterior (B) point, representing the AP diameter (d₃). The most posterior boundary of MPPA (C) and the most anterior boundary of DMA (D) were similarly marked. Distances between B and C (d₁) and between B and D (d₂) were measured as well as the anterior-posterior diameter of the condyle (d₃). The same measurements were made for the lateral condyle.

RESULTS

On the medial condyle, the average values of d₁, d₂, and d₃ were 10.8 mm ± 3.8, 17.3 mm ± 3.3, and 60.1 mm ± 3.2, while percentages of d₁/d₃ and d₂/d₃ were 18.3% ± 6.4 and 28.7% ± 4.7. In lateral condyle, the averages for d₁, d₂, d₃ were 6.1 mm ± 1.4, 12.1 mm ± 2.8 and 60.9 mm ± 3.3 mm and the percentages of d₁/d₃ and d₂/d₃ were 10.1% ± 2.3 and 19.9% ± 4.9.

CONCLUSIONS

When the Hoffa fragment is less than 18.3% of the AP diameter of medial condyle or 10.1% of lateral condyle, the fracture is invisible with the PPA. When the Hoffa fragment is more than 28.7% of the medial condyle or 19.9% of the lateral condyle, the PPA should be selected. If the Hoffa fragment is less than 28.7% of the medial condyle or 19.9% of the lateral condyle, the DMA or PLA with posterior-to-anterior screws is recommended. Combined approaches should be considered in some complex cases with articular comminution.

The Hoffa fracture: Coronal fracture of the femoral condyle a review of literature

This article aims to provide a systematic review of the limited literature and clinical knowledgebase available on the Hoffa fractures. It is inclusive of the normal anatomy, pathology, diagnosis, treatment options comprising of non-operative and operative protocols, and postoperative findings.

A rare case of Hoffa fracture combined with lateral patellar dislocation

The coronal unicondylar fracture of the distal femur (AO 33-B3) is a rare intraarticular injury within the weight bearing area of the knee, initially described by Albert Hoffa in 1904. We report an unusual combination of a Hoffa fracture with lateral patellar dislocation in a young adult. Our patient sustained the injury by a sudden twist of his leg during sports. He presented clinically with knee swelling, dislocation of the patella, and localized tenderness; unable to bare weight. After plane radiograph confirmed the injury, manual reduction of the patella was done by hyperextension of the knee and medialward pressure. Afterwards, a CT scan and MRI were conducted. The injury was surgically treated with lag-screws, locking-plate and MPFL-reconstruction.

Operative Treatment of Isolated Bicondylar Hoffa Fracture With a Modified Swashbuckler Approach

Introduction:

An isolated coronal fracture of either or both femoral condyles is a rare entity and is usually associated with high-energy injury trauma. Such fractures should be meticulously fixed for a good functional outcome as they involve the articular surface of a weight bearing joint. A modified swashbuckler approach provides adequate exposure for appropriate reduction and fixation of such fractures.

Case Presentation:

A 32-year-old male sustained a bicondylar Hoffa fracture of the right femur which was treated by open reduction and internal fixation using a modified swashbuckler approach. At two years of follow-up, the patient had excellent radiological and functional outcome.

Conclusions:

In our study, we treated this rare fracture successfully using a modified swashbuckler approach and found it to be a good approach for such fractures as compared to the conventional approach.

Hoffa Fracture of the Femoral Condyle

In this report, we present a case of an uncommon coronal fracture of the femoral condyle, known as a Hoffa fracture. Classification of these injuries and commonly associated injuries are discussed. We describe previously proposed mechanisms of injury and review the current literature. The difficulty in establishing radiologic diagnosis on the basis of radiography exclusively is emphasized. Finally, current approaches to operative fixation are outlined.

Hoffa fracture of medial unicondylar and bilateral in a man: a rare case

Intra articular Coronal fracture of the femoral condyle (Hoffa) is rare-especially that of medial condyle. We report the case of a patient who had a bilateral Hoffa fracture of the medial condyles (type 33 - B3, Orthopaedic Trauma Association) occurred as a result of an accident at work (worker mover). Lesions were treated with the functional and orthopaedic approach. At follow- up of 8-month functional score was excellent with normal flexion, an absence of laxity, an absence of pain and an unlimited market. Through a review of the literature the mechanism, the diagnostic methods and therapeutic will be analysed.

Irreducible, incarcerated vertical dislocation of patella into a Hoffa fracture

Rotational dislocations of patella, which involve rotation of the patella around a horizontal or vertical axis are rare. These rotational dislocations of patella are difficult to reduce by close methods. These dislocations can have associated osteochondral and retinacular injury. We report a case of a 20-year-old male who presented with swelling and pain in the right knee following a motor cycle accident. Radiological evaluation using the computed tomography revealed a patellar dislocation with a concomitant Hoffa fracture. Patella was rotated around the vertical axis and was incarcerated into the Hoffa fracture. This is a very rare injury and first of its kind to be reported. The difficulties in diagnosis, mechanism of injury and management have been discussed. We feel closed reduction of such an injury is likely to fail and open reduction is recommended.

A rare case of unicondylar medial Hoffa fracture associated with ipsilateral vertical patella fracture

An 18 year old male patient was hit by a car to his motorcycle causing a unicondylar Hoffa fracture and an ipsilateral patella fracture. Hoffa fracture is a rare lesion and this association of injury has not been reported before.