The articular surface of medial femoral condyle was anatomically reduced. Management of hoffa fractures and fixation principles dr. Operative fixation of the bimalleolar ankle fracture, performed during the same session, was uneventful and immaterial to the subsequent management of the. Hoffa fracture is a type of supracondylar distal femoral fracture and is characterized by an associated fracture component in the coronal plane. The nature of the fracture pattern makes it both radiologically and clinically difficult to diagnose. Pdf arthroscopic management of a posterior femoral. We report the case of an 18yearold male who sustained a closed complex. Hoffa fracture rehabilitation kumar s, siddiqui za, kumar. Pdf operative management of hoffa fracture of the femoral. A bicondylar hoffa fracture is an extremely rare injury, and only five cases have been reported so far in the literature. For over forty years, the principles regarding fracture management have been taught by ao, and these textbooks are a carefully edited version of the knowledge with contributing. Operative treatment of isolated bicondylar hoffa fracture with a. In the case we present here, the hoffa fracture occurred after minimal trauma and was associated with an ipsilateral patellar dislocation and a. Letenneur classification9 hoffa fracture his management, complications and outcomes.
Nonunion and malunion have been reported when hoffa fracture was managed conservatively 6,7. The treatment of a hoffa fracture is similar to that of any intraarticular fracture. Jun 09, 2014 hoffa s fracture coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. Aug 02, 2017 distal femur fractures assessment and preop planning ota lecture series iii l5a duration. In a flexed position, the posterior portion of the. Dec 07, 2015 the hoffa fracture is an uncommon, coronallyoriented fracture which extends through either the medial or lateral condyle.
Few studies have been published on bicondylar hoffa fractures demonstrating satisfactory to good outcomes at. The four goals of hoffa fracture treatment consist of anatomicalreduction ofthe articular surface, preservation ofthe blood supply through the use of minimally. However, several small studies have demonstrated goodtoexcellent functional results after anatomical reduction and rigid fixation of the hoffa fracture, followed by early mobilization. They are isolated fractures of the femoral condyle and rare in occurrence. Conservative management often leads to unsatisfactory results and nonunion. They are rare and account for less than 1% of distal femoral fractures. A coronal fracture of a femoral condyle hoffa fracture is an unusual injury and there are only a handful of reports discussing it. Functional outcome of isolated hoffa fractures treated with. Functional outcome of isolated hoffa fractures treated. Twentysevenyear nonunion of a hoffa fracture in a 46yearold. Unicondylar fractures of the lower end of the femur are uncommon injuries that usually occur in the sagittal plane. Pdf hoffa fracture is a rare injury consisting of unicondylar tangential posterior fracture of the distal femur and only very few cases have been.
A total of 12 isolated lateral hoffa fractures were identified during the study period february 2005 to february 2010. Nonunion of a hoffa fracture in an adult springerlink. Coronal plane fractures of femoral condyles first described by hoffa in 1904, 1 representing only 0. The bone union of medial hoffa fractures was achieved in all patients. Hoffa fracture of the femoral condyle pubmed central pmc. A comparison of the clinical effect of two fixation methods. The mechanism of injury is usually high energy, often associated with multiple injuries and so can easily be overlooked. Although occasionally bicondylar, the hoffa fragments are more commonly unicondylar and usually originate from the lateral femoral condyle 3, 4. Coronal fractures of the femoral condyles are rare injuries.
First described hoffa, a new classification system by bagaria et al helps plan the surgery for these tricky fracture. The hoffa fracture is a rare unicondylar fracture of the lower femur that occurs in the coronal plane. A proposed radiological classification system of hoffas fracture. Reduce if displaced may be by open reduction, closed manipulation, or traction 3. Bicondylar hoffa fracture successfully treated with headless. These fractures are frequently comminuted and intraarticular, and they often involve osteoporotic bone, which makes it difficult to. Surgical management of complex intraarticular distal femoral and bicondylar hoffa fracture d giotikas, m nabergoj, m krkovic cambridge university hospitals nhs foundation trust, cambridge, uk abstract bicondylar hoffa s fractures of distal femur are rare. All coronal fractures of the lateral femoral condyle were exposed by the swashbuckler modified anterior approach fig.
He sustained a right closed mid shaft of femur fracture and left closed hoffa fracture fig. They were described by hoffa in 1904 and are known as hoffa fractures ao type b3. We present a case of isolated unilateral bicondylar hoffa fracture that was successfully treated with open reduction and internal fixation using headless compression screws with satisfactory results. Operative treatment of unilateral bicondylar hoffa fractures. The hoffa fracture is an uncommon, coronallyoriented fracture which extends through either the medial or lateral condyle. A coronal tangential plane fracture, first described by hoffa in 1904, is unusual. Cureus a case of distal femur medial condyle hoffa type ii. The coronal fractures of femoral condyles, known as hoffa fractures, are a rarity. A high degree of suspicion is warranted to avoid missing these. The objective in the treatment of these fractures is to achieve anatomical reduction of the articular surface and a stable fixation to. One of the first steps of management is the need to assess injury to other organ systems with general surgery colleagues before proceeding with management of distal femur fractures. Operative management of hoffa fracture of the femoral condyle. Sep 24, 20 healing of fracture a fracture begins to heal as soon as the bone is broken provided the conditions are favorable.
Hoffa fragment associated with a femoral shaft fracture. The hoffa fracture is a unique and relatively uncommon clinical entity that has a different personality than other intraarticular fractures of the knee in both adults and children. We report a case of 19yearold female injured during a fall and suffered medial condyle hoffa fracture. Type b fractures are subclassified based on the involved condyle.
A is the least severe type of fracture, with two bone fragmentsof fracture, with two bone fragments onlyonly 2 the group. Introduction hoffas fracture is an eponymous term to denote the intraarticular fracture of distal end of the femur in coronal plane accounting for 0. A ct scan is obtained which shows intraarticular extension of the fracture, and lateral locked plating with intercondylar lag screw fixation is planned. A comparison of the clinical effect of two fixation methods on hoffa fractures yi xu1, heng li1, hong. Results a new proposed radiological classification for hoffa fracture consists of four main types. Management of hoffa fractures and fixation principles by dr. General anesthesia was administered, and the patient was placed supine on a radiolucent operating table. The fracture was dealt with based on the principles of intraarticular fracture management 7,8. Unicondylar fractures of the femur that occur in the coronal plane hoffa fractures are uncommon and most often affect the lateral condyle. Introduction hoffa s fracture is an eponymous term to denote the intraarticular fracture of distal end of the femur in coronal plane accounting for 0. Bicondylar hoffa fracture successfully treated with. This fracture pattern was initially described by hoffa in 1904 1 hence the name for this fracture. These injuries can often be open and involve both condyles, and. Type b3 fractures or coronal plane hoffa fractures of the posterior femoral condyle are prevalent in up to 38% of intercondylar fractures and may elude initial detection on orthogonal plain films.
When the valgus test was done intraoperatively, the. Isolated hoffa fracture of the medial femoral condyle in a. The unicondylar tangential posterior fracture of the femur. Hoffa fracture rehabilitation kumar s, siddiqui za, kumar s. A comparison of the clinical effect of two fixation.
Pdf technique of reduction and fixation of unicondylar. Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of hoffa fractures. An isolated coronal fracture of either or both femoral condyles is an unusual injury. Intraarticular fractures of the femoral condyles in the coronal plane are rare. Jaaos journal of the american academy of orthopaedic. Rehabilitate r esuscitate advanced trauma life support. A classification scheme for subtyping of hoffa fractures based on location within the condyle has previously been proposed. Case report a 34yearold male construction worker presented after a 300 kg concrete beam fell from a crane onto his thighs. The mechanism of injury of hoffa fracture is still unknown and the operation approch and fixation method are. Hoffa fracture is an unusual injury, most commonly affecting the lateral condyle. First mentioned by friedrich busch in 1869, this fracture was later named after albert hoffa in 1904.
Pdf ao principles of fracture management download full. Retain to maintain position while healing occurs by internal fixation, external fixation, or conservative methods 4. An 18yearold male sustained a closed complex intraarticular fracture of both femoral condyles of the left femur in the sagittal plane hoffa fracture, combined with a comminuted distal metaphyseal fracture as a result of a motorbike accident. The imaging evaluation of distal femoral fractures is based primarily on conventional radiographs. Hoffa s fracture coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. Bicondylar coronal plane fracture, eponymically named hoffa fractures, is an extremely rare injury. Surgical treatment of lateral hoffa fracture with a. This was treated by open reduction and internal fixation using two headless compression screws.
Various authors described varying exposures for these fractures. Mcdonough and bernstein7 reported a case of hoffa fracture of the lateral femoral. Fragment displacement may occur during placement of an angled blade plate or its seating chisel, and if unrecognized, postoperative displacement may necessitate a second surgery 3. Operative fixation warranted a good functional outcome. This report illustrates that a coronal plane fracture can coexist with an ipsilateral femoral shaft fracture despite the absence of a supracondylar, intercondylar, or femoral neck component. Technique of reduction and fixation of unicondylar medial hoffa fracture article pdf available in american journal of orthopedics belle mead, n.
Apr 27, 2010 hoffa fractures are uni or bicondylar fractures of the distal femur in a coronal tangential plane. We report a case of a 52yearold worker who fell from a height, suffering lower limb injuries, including a hoffa fracture with comminution, and had problems with malunion during the postoperative period. How to determine the surgical approach in hoffa fractures. There was an evident gap between the fractured medial condyle and the displaced condylar fragment fig. Management fracture management stages include 4 rs. Pdf a proposed radiological classification system of. Hoffa fracture is an uncommon partial articular coronallyoriented fracture which extends through either the medial or lateral condyle.
Surgical management of complex intraarticular distal femoral. Clinical experience with management of hoffa fractures using. Type c fractures also may have condylar fracture lines in the coronal plane. Hoffa fracture accompanied by dissection of the popliteal. Hoffa fractures are rare and difficult to treat for orthopaedic surgeons. A modified swashbuckler approach provides adequate exposure for appropriate reduction and fixation of such fractures.
Current concepts abstract the diversity of surgical options for the management of distal femoral fractures re. Cureus a case of distal femur medial condyle hoffa type. Repair of displaced partial articular fracture of the distal. All fractures were treated by open reduction through the lateral approach. Overlooked hoffa fracture in a patient with neurofibromatosi. The hoffa fracture is an intraarticular fracture of the knee analogous to the capitellum fracture of the elbow 2. First described by albert hoffa, these accounts for less than 1% of distal femoral fractures. Surgical treatment and rehabilitation of medial hoffa fracture fixed by. We inserted posteroanteriorly oriented acutrak screws perpendicular to the fracture plane via. Coronal plane partial articular fractures ie, hoffa are designated as type b3.
The hoffa fracture a fracture not to miss emergency. This injury is the result of violent force and generally occurs in young adults. The purpose of this study was to evaluate the functional outcome and complications of surgically managed hoffa fractures with cannulated cancellous screw. These fractures are due to high energy trauma and conservative treatment generally yields poor results, but rigid internal fixation allows early functional rehabilitation and decreases the incidence of complications. Surgical management of complex intraarticular distal femoral and bicondylar hoffa fracture d giotikas, m nabergoj, m krkovic cambridge university hospitals nhs foundation trust, cambridge, uk abstract bicondylar hoffas fractures of distal femur are rare. Arthroscopic management of a posterior femoral condyle hoffa fracture.
Long term followup of an open bicondylar hoffa fracture. Diagnosis of a coronal fracture is often missed in conventional radiography, so additional cts of the knee are highly recommended in unclear cases. In treating a fracture, the objectives of the treatment are as follows. Hoffa fracture is a rare injury consisting of unicondylar tangential posterior fracture of the distal femur and only very few cases have been reported in the literature. This retrospective case series included patients with coronal fractures of the femoral condyles managed operatively. A careful examination along with oblique radiographs and computed tomography scan is needed for an accurate diagnosis. Hoffa fractures are uncommon intraarticular fractures of femoral condyle in coronal plane. Coronal plane fractures of the distal femur are less frequent compared to sagittal plane fractures. This injury is classified as a type 33b3 fracture by the orthopaedic trauma association. It is an intrinsically unstable type of intraarticular fracture that warrants operative fixation, usually by an open technique.
Operative management of hoffa fracture of the femoral. This video presents a case of surgical repair of a hoffa fracture, and contaminant meniscal repair, in a. Operative management of hoffa fracture of the femoral condyle article pdf available in acta medica iranica 526. Arthroscopic management of a posterior femoral condyle hoffa. These fractures are due to high energy trauma and conservative treatment generally yields poor results, but rigid internal fixation allows early functional rehabilitation and. A computed tomographybased classification of hoffa fracture. Fractures of femoral condyle in coronal plane are commonly known as hoffa fractures. Supracondylar distal femoral fractures may be classified as extraarticular, unicondylar, or bicondylar, and the fractures may have an intercondylar extension 1, 2.
Isolated hoffa fracture is an infrequent injury and little research has been done on this subject. Operative treatment of hoffa fractures yields fairly good functional. Conservative management is associated with poor results due to continuous shear stresses imposed on the fracture. Praveen mareddy orthopedic surgeon, care hospitals. A proposed radiological classification system of hoffas. Pdf operative management of hoffa fracture of the femoral condyle. Surgical management of complex intraarticular distal. The goal of this study is to determine the efficacy of the surgical treatment of lateral hoffa fracture with a locking plate and cannulated or lag screws through the lateral approach. Mediolateralradiographsof knees joint showing a bilateral hoffa fracture of the medial femoral condyle and fracture suspicion of left tibia plateau. Distal femur fractures assessment and preop planning ota lecture series iii l5a duration. Because of permanent shearing forces, fracture healing is unlikely without surgical treatment. Partial articular, coronal plane fractures of the posterior part of femoral condyles are called hoffa fractures. Arthroscopic management of a posterior femoral condyle. In this study, we present a case of a 35yearold patient with an established nonunion of medial hoffa fracture of right knee treated with open reduction and internal fixation.
A medial condyle hoffa fracture is even rare with very few cases reported in the literature. A hoffa fracture is an intraarticular supracondylar distal femoral fracture, characterized by a fracture in the coronal plane. Fractures involving the lateral condyle are more common than medial fractures, while fractures involving both condyles are extremely rare. Epidemiology while they are rare in absolute numbers, they can account for approximately 40% of int. This approach is suitable for the treatment of hoffa fracture with patella dislocation. Hoffa fractures are often reported in combination with other femoral fractures. In one study on supracondylar intercondylar fractures of distal femur, 38% had a coronal fracture. The standard reference book in operative fracture care. However, such an injury in a skeletally immature individual poses special problems due to the presence of an open physis. Deformity correction using the sandwich technique for a. Hoffa fractures are coronalplane fractures of the femoral condyle. Surgical management with anatomical reduction and rigid fixation allows early functional rehabilitation.
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