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.

The Hoffa Fracture: Review

The Hoffa fracture is an extremely rare injury of one or two condyles of the femur in the frontal plane, more often associated with injury to other structures of the knee joint area. The main cause of the Hoffa fracture is considered to be a high-energy injury (road accident in 80.5% of cases). The isolated Hoffa fracture accounts for 0.65% of all femoral fractures. To date, there is no consensus on surgical approach or optimal technique of internal fixation for the frontal fracture of the femoral condyles. There is also a large percentage of mistakes in the X-ray diagnosis of this pathology. The existing classifications have not found wide application in clinical practice, being difficult and inapplicable for solving the issue of treatment tactics and preoperative planning. The aim of the study is to present modern views on the diagnosis, principles and techniques of surgical treatment of patients with the Hoffa fractures based on the analysis of the literature. Based on the analyzed literature, conclusions are drawn about the need for careful collection of injury anamnesis, increased surgeon caution in the presence of this injury clinical picture and the simultaneous absence of pathology on standard knee joint X-rays, the need to perform an additional examination in the form of lateral (non-standard) projections of the knee joint X-rays, CT or MRI. During preoperative planning, preference should be given to minimally invasive technologies, including arthroscopically-associated methods of treatment.

An Uncommon Trauma: Hoffa's Fracture Associated with Tibial Avulsion Fracture of the Posterior Cruciate Ligament

BackgroundSince Hoffa fractures are usually the result of high-energy injuries, many additional accompanying injuries have been described. This is the first paper representing the lateral condyle Hoffa fracture accompanying tibial avulsion fracture of the posterior cruciate ligament (PCL).Case PresentationA 42-years-old male presented with swelling and instability in his left knee after falling during parachute landing. He was diagnosed with simultaneous Letenneur Type I lateral condyle Hoffa fracture and tibial avulsion fracture of the PCL. He was operated on with a single posterior incision for both fractures. Multiple cannulated lag screws were used for the fixation of the Hoffa fracture, and a buttress plate was used for additional stability. PCL avulsion fracture was fixed with a cannulated screw with a washer. The patient was allowed for full-weight-bearing and range of motion at the sixth week after the operation. No complications occurred during follow-up.ConclusionCare should be taken in terms of additional injuries that may accompany Hoffa fractures. The posterior approach allows easy access to both fractures with a single incision. Using a buttress plate after the fixation of the Hoffa fracture with multiple lag screws provides additional stability.

Distal femoral osteotomy for genu valgum deformity caused by malunited Hoffa fracture

Hoffa fractures are unstable intra-articular fractures of the femoral condyle that occur in the coronal plane.Insufficient anatomical reduction and internal fixation may lead to non-union or malunion. A 39-year-old man was involved in a traffic accident while riding a motorcycle and was diagnosed with left Hoffa fracture and avulsion fracture of the femoral attachment of the medial collateral ligament. Open reduction and internal fixation were performed 5 days after injury. The patient experienced intermittent knee pain, joint contracture and deformity, and attended our hospital for further treatment 18 months after surgery. CT revealed depression and malunion of the posterior aspect of the lateral femoral condyle, and weight-bearing X-ray showed valgus deformity due to malunion. Distal femoral osteotomy (DFO) was performed and good functional and radiographic results were obtained. This report suggests that DFO is a reasonable treatment for young patients suffering from malalignment due to malunited Hoffa fracture.

Non -Union of Lateral Hoffa Fracture - A Case Report

Introduction: Hoffa is a coronal fracture of the femoral condyle. It is an uncommon injury easily missed on X-rays, which later presents as a non-union. Computed tomography (CT) scan knee helps in diagnosing undisplaced fractures and planning the management. Case Report: A 24-year-old male patient presented to us with complaints of pain, decreased range of knee movements, difficulty in walking and clicking sound at the left knee for 9 years. The patient had a history of trauma 9 years back. X-ray of the left knee showed the non-union of left lateral Hoffa fracture, which was managed with open reduction and internal fixation with CC screws using the lateral para patellar approach. At present 1.5 years follow-up, the patient is comfortable with no pain and having a complete knee range of motion. Conclusion: Although Hoffa fracture is rare, clinical suspicion, along with radiological investigations, is essential to diagnose Hoffa fracture. A missed diagnosis can lead to malunion or non-union, which predisposes to knee arthritis. Timely and proper management of Hoffa non-union with open reduction, stable internal fixation and early knee mobilization help in getting a better outcome. Keywords: Lateral Hoffa fracture, non-union, internal fixation, functional outcome.