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Background: Hoffa's fracture is a coronal oriented fracture of the femoral condyles. Isolated
coronal fracture of medial femoral condyle with intact lateral femoral condyle is extremely rare
in the pediatric patients. There are only few cases of a medial femoral condyle Hoffa's fracture in
a skeletally immature patient that have been reported in th...
Contexts in source publication
Context 1
... 12-year-old boy presented to our emergency department with right knee pain and inability to bear weight. History revealed that the patient sustained an injury from a heavy object that fell on his knee. Clinical examination revealed that his knee was swollen and tender, but had no open wounds and the range of motion was restricted due to pain. Neurovascular examination was normal with no signs of compartment syndrome. Radiographs of the knee revealed a medial Hoffa's fracture (Fig. 1) three-dimensional reconstruction showed a displaced medial condyle coronal fracture with comminution (Fig. 2). Surgical treatment with means of open reduction and internal fixation was planned. The fracture was exposed through a medial parapatellar approach (Fig. 3). Under the guidance of an image intensifier, the fracture was reduced with the aid of a bone clamp and two 4.0 mm partially threaded cancellous screws, which were placed perpendicular to the fracture line. To achieve a more posterior purchase of the fragment, passing the superior screw through the physis couldn't be avoided. The screw heads placed through the articular cartilage were countersunk. Following open reduction and internal fixation, the patient was kept on an above-knee back slab with 30° of knee flexion for approximately 2 weeks. After 2 weeks, he was placed into a removable posterior splint for 4 weeks and gradual range-of- motion exercises of knee were initiated. Strict instructions were given to avoid any weight-bearing flexion during this six-week period to minimize shear force on his coronal fracture pattern. Partial weight-bearing was allowed after 6 weeks postoperatively. At 10 weeks postoperatively, he gradually progressed to full weight-bearing. At six-month follow-up, he was walking without support and without pain and the knee range of motion was 15 to 130° (Fig. 4). Additionally, there was neither an angular deformity nor a limb-length discrepancy. Plain radiographs and CT showed a well-healed fracture with no evidence of collapse of the femoral condyle (Figs. 5-6). Screws were planned to be removed in 9 months' ...
Context 2
... 12-year-old boy presented to our emergency department with right knee pain and inability to bear weight. History revealed that the patient sustained an injury from a heavy object that fell on his knee. Clinical examination revealed that his knee was swollen and tender, but had no open wounds and the range of motion was restricted due to pain. Neurovascular examination was normal with no signs of compartment syndrome. Radiographs of the knee revealed a medial Hoffa's fracture (Fig. 1) three-dimensional reconstruction showed a displaced medial condyle coronal fracture with comminution (Fig. 2). Surgical treatment with means of open reduction and internal fixation was planned. The fracture was exposed through a medial parapatellar approach (Fig. 3). Under the guidance of an image intensifier, the fracture was reduced with the aid of a bone clamp and two 4.0 mm partially threaded cancellous screws, which were placed perpendicular to the fracture line. To achieve a more posterior purchase of the fragment, passing the superior screw through the physis couldn't be avoided. The screw heads placed through the articular cartilage were countersunk. Following open reduction and internal fixation, the patient was kept on an above-knee back slab with 30° of knee flexion for approximately 2 weeks. After 2 weeks, he was placed into a removable posterior splint for 4 weeks and gradual range-of- motion exercises of knee were initiated. Strict instructions were given to avoid any weight-bearing flexion during this six-week period to minimize shear force on his coronal fracture pattern. Partial weight-bearing was allowed after 6 weeks postoperatively. At 10 weeks postoperatively, he gradually progressed to full weight-bearing. At six-month follow-up, he was walking without support and without pain and the knee range of motion was 15 to 130° (Fig. 4). Additionally, there was neither an angular deformity nor a limb-length discrepancy. Plain radiographs and CT showed a well-healed fracture with no evidence of collapse of the femoral condyle (Figs. 5-6). Screws were planned to be removed in 9 months' ...
Context 3
... 12-year-old boy presented to our emergency department with right knee pain and inability to bear weight. History revealed that the patient sustained an injury from a heavy object that fell on his knee. Clinical examination revealed that his knee was swollen and tender, but had no open wounds and the range of motion was restricted due to pain. Neurovascular examination was normal with no signs of compartment syndrome. Radiographs of the knee revealed a medial Hoffa's fracture (Fig. 1) three-dimensional reconstruction showed a displaced medial condyle coronal fracture with comminution (Fig. 2). Surgical treatment with means of open reduction and internal fixation was planned. The fracture was exposed through a medial parapatellar approach (Fig. 3). Under the guidance of an image intensifier, the fracture was reduced with the aid of a bone clamp and two 4.0 mm partially threaded cancellous screws, which were placed perpendicular to the fracture line. To achieve a more posterior purchase of the fragment, passing the superior screw through the physis couldn't be avoided. The screw heads placed through the articular cartilage were countersunk. Following open reduction and internal fixation, the patient was kept on an above-knee back slab with 30° of knee flexion for approximately 2 weeks. After 2 weeks, he was placed into a removable posterior splint for 4 weeks and gradual range-of- motion exercises of knee were initiated. Strict instructions were given to avoid any weight-bearing flexion during this six-week period to minimize shear force on his coronal fracture pattern. Partial weight-bearing was allowed after 6 weeks postoperatively. At 10 weeks postoperatively, he gradually progressed to full weight-bearing. At six-month follow-up, he was walking without support and without pain and the knee range of motion was 15 to 130° (Fig. 4). Additionally, there was neither an angular deformity nor a limb-length discrepancy. Plain radiographs and CT showed a well-healed fracture with no evidence of collapse of the femoral condyle (Figs. 5-6). Screws were planned to be removed in 9 months' ...
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Citations
... These fractures are mostly resulting from direct high-energy trauma, which causes a shear force on the posterior femoral condyle. The usual cause of Hoffa's fracture is motorcycle accidents [7]. When a Hoffa fracture is suspected, an X-ray must be planned first, and for better evaluation of the lesion, a CT scan must be performed or sometimes even magnetic resonance imaging. ...
Introduction
Hoffa fractures are uncommon fractures in adults and less common in children. They are defined as fractures of the femoral condyles that occur in the coronal planes. To this day, Hoffa fractures in children comprise only of case reports.
Case Report
Our case report is focused on a 12-year-old patient victim of a high-impact trauma causing a bicondylar Hoffa fracture. The diagnosis was based on an X-ray in front and lateral views and confirmed by a computed tomography scan and 3D reconstructions. A screw fixation truth open reduction with a lateral approach. We report the satisfactory results of our case after a 24-month follow-up with a good range of motion.
Conclusion
To avoid necrosis of the fragment, pain and stiffness at long-term follow-up make the management of this fracture a serious challenge, and in the pediatric population, the prevention of growth cartilage injuries is crucial to accurate management.
... Mushtaq et al [41] Medial Two headless screws PA Parapatellar Case report and literature review Harna et al [32] Medial Locking plate and 1 6.5mm cannulated cancellous screw and 1 4.5mm Herbert screw PL Medial subvastus Case report Sun et al [86] Medial type III * two 4.5-mm cannulated cancellous lag screws AP Arthroscopic Case report Ranjan et al [87] Medial two 4.5 mm partially threaded cannulated cancellous screws PA Medial (not specified) Clinical case and literature review Jiang et al [88] Medial type III* Three 3.5-mm cannulated cancellous screws PA Posteromedial Case report AlKhalife et al [89] Medial Two 4.0 mm partially threaded cancellous screws AP Medial parapatellar Case report Zhang et al [90] Medial type II* Two percutaneous 6.5 mm partially threaded cannulated cancellous screws; 2 compression screws and 2 3.5 mm reconstruction plates PA and AL Parapatellar arthrotomy and medial ...
Background
Accomplish a thorough review on the existing biomechanical and clinical studies about coronal plane fractures of the distal femur.
Methods
We performed an electronic search of PubMed/MEDLINE database from April to June, 2023. The terms for the database search included “Hoffa fractures,” OR “Busch-Hoffa fractures” OR “coronal plane fractures of the distal femur.”
Results
The search identified 277 potentially eligible studies. After application of inclusion and exclusion criteria, 113 articles were analyzed in terms of the most important topics related to coronal plane fractures of the distal femur.
Conclusion
Lateral coronal plane fractures of the distal femur are more frequent than medial, present a more vertical fracture line, and usually concentrate on the weight bearing zone of the condyle. The Letenneur system is the most used classification method for this fracture pattern. Posterior-to-anterior fixation using isolated lag screws (for osteochondral fragments—Letenneur type 2) or associated with a posterior buttressing plate (when the fracture pattern is amenable for plate fixation—Letenneur types 1 and 3) is biomechanically more efficient than anterior-to-posterior fixation. Anterior-to-posterior fixation using lag screws complemented or not by a plate remains a widely used treatment option due to the surgeons’ familiarity with the anterior approaches and lower risk of iatrogenic neurovascular injuries. There is no consensus in the literature regarding diameter and number of screws for fixation of coronal plane fractures of the distal femur.
... Isolated medial Hoffa fracture in a child is extremely rare. To our knowledge, only three cases has been reported in the literature [3,4]. ...
... In 1978, Letenneur et al. [8] The principles of treatment of these fractures are similar to those of typical intra-articular fractures. Open reduction with internal fixation is the gold standard treatment to achieve better functional outcomes [4]. Arthroscopically assisted reduction and internal fixation was also described [9]. ...
Hoffa's fracture is defined as a fracture of the femoral condyle in the coronal plane. It's more common in the lateral condyle and often described in adult. We report a rare case of Hoffa's fracture of medial condyle in immature skeleton in 10-year-old girl. The diagnosis was suspected in the X-Ray and confirmed by CT-scan. The patient was treated by open reduction and internal fixation. At two years follow up, the clinical and radiological outcomes were good. Hoffa's fracture of the medial condyle is exceptional in paediatric population. Diagnosis can be missed requiring CT-scan confirmation. The reduction of this fracture must be anatomical to prevent complications.
... Hoffa's fractures of the lateral femoral condyle are commonly seen, while Hoffa's fractures of the medial femoral condyle are rare, especially in individuals with undeveloped skeletons. The latest case was a 16-year-old girl with Hoffa's fracture of the medial femoral condyle reported by Jiang et al [2] in 2022. This type of fracture is an intraarticular fracture and is clinically treated under the same principles as a typical intra-articular fracture. ...
Background:
Hoffa's fracture is a coronal-oriented fracture of the femoral condyle. It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral femoral condyle. Only a few cases involving Hoffa's fracture of the medial femoral condyle have been reported in patients with undeveloped skeletons. Such a fracture cannot be observed by routine imaging examinations, thus resulting in possible misdiagnosis and further treatment challenges.
Case summary:
A 5-year-old boy with Hoffa's fracture of the medial femoral condyle suffered from right knee pain and severe swelling after being hit by a heavy object. The patient was misdiagnosed and initially treated in a local primary healthcare center. No improvement in his right knee's extension was observed following conservative treatment for 2 wk. The patient was transferred to our hospital, re-diagnosed using arthroscopy, and underwent open reduction and internal fixation. The therapeutic outcome was satisfactory with the screws removed 7 mo after fixation. At the final follow-up of 40 mo, the range of motion in the knee had recovered. There was no varus-valgus instability.
Conclusion:
Hoffa's fracture is rarely seen in children aged 5 years, let alone in the medial condyle, and can easily be misdiagnosed due to limited physical and imaging examinations. Suspected Hoffa's fracture in preschool children should be confirmed based on arthroscopic findings. Open reduction and internal fixation should be performed to protect the articular surface and prevent long-term complications.
... Therefore, advanced imaging utilities could be of a great value in diagnosis of these fractures especially when there is a suspicion of abnormality at standard x ray films. According to our knowledge seven cases were reported in the literatures discussing Hoffa fractures in skeletally immature patients until last search at 30 august 2019 ( Table 1) [4][5][6][7][8][9][10] . Five of these seven cases were fresh fractures and early managed operatively with different approaches and different techniques and the result were satisfactory [4][5][6][7][8]. ...
... According to our knowledge seven cases were reported in the literatures discussing Hoffa fractures in skeletally immature patients until last search at 30 august 2019 ( Table 1) [4][5][6][7][8][9][10] . Five of these seven cases were fresh fractures and early managed operatively with different approaches and different techniques and the result were satisfactory [4][5][6][7][8]. However, only two cases were described in the literatures as a missed Hoffa fracture in an eight year old girl and twelve year old boy went to a nonunion which managed operatively and fixed with cannulated screws and the result were satisfactory in the 1st case the child has virtually full range of motion of the knee and no evidence of growth disturbance, also in the second case radiographic union was observed after 3 months, and after 2 years of follow-up, the child had excellent functional outcome [9,10]. ...
Figure 1: Clinical examination to the knee with neglected Hoffa fracture showing a positive posterior sag sign, the black arrow showed the normal position of the tibia in the upper(A) picture and the posterior sagging in the lower (B) picture. Abstract Hoffa fractures are uncommon clinical entity typically seen in adults after high-energy trauma, and commonly missed. Moreover, it's extremely rare in children and young adolescents. According to our knowledge only 7 cases were reported in the literature with coronal fracture of the femoral condyle in children and young adolescents until the last search in 30 August 2019. Five of these seven cases discussed fresh fractures and other two cases discussed a missed Hoffa fractures complicated with non-union. In this study we present another case of missed coronal fracture of the lateral femoral condyle that subsequently went on to non-union and pseudoarthrosis in a 12 years old boy. The patient presented 4 months after motor vehicle accident with symptoms of right knee pain, snapping and instability. Radiological evaluation revealed a non-united lateral Hoffa fracture. The non-united fragment involved about two third of the lateral femoral condyle. operative intervention was our decision, diagnostic arthroscopy was done 1st then open arthrotomy using anterolateral approach for excision of pseudoarthrosis, open reduction and internal fixation of the fracture. Six months postoperative outcome was satisfactory, with full range of motion and return to sport. .
... Bicondylar Hoffa fracture typically results from direct trauma combined with axial loading with knee in flexion. 5 Isolated Hoffa's fracture of femoral condyle was described for the first time by Bali et al. 6 Alkhalife et al. 7 have reported that paediatric Hoffa's fracture can be easily missed and has recommended open anatomic reduction to avoid long term complications. Salunke et al. 8 have emphasized the importance of thorough clinical examination followed by appropriate imaging to avoid missing this injury. ...
Epiphyseal injuries of distal femur are rare with an incidence of 1%e6% among all physeal injuries.Prompt diagnosis and appropriate surgical treatment is crucial to achieve satisfactory functional out-comes. A conjoint bicondylar coronal split (Hoffa) fracture with complete transaction of ipsilateralpatellar tendon has been reported in a 12 year old child. The injury was managed by open reduction andinternalfixation and bone to tendon repair. This case emphasizes the need of accurate intraepiphysealfixation for the management of these fractures in skeletally immature patients.
Objective: Rare disease Background: Hoffa fractures are an uncommon form of coronal fracture that impact the femoral condyle. As a result, they are not very prevalent. It is necessary to perform anatomical reduction and rigorous fixation on these fractures; however, there is no consensus among medical professionals on the surgical procedure and implant that would be the most successful in treating these fractures. Case Report: A 50-year-old woman who had poliomyelitis in her right lower limb presented with a displaced medial Hoffa fracture of her left knee. She had fallen and was suffering from poliomyelitis. The trauma that caused this fracture had a modest energy level. Open reduction and internal fixation with 2 retrograde cannulated screws were included in her surgical procedure. An approach known as the medial parapatellar route was used for this treatment. As part of her postoperative rehabilitation, she participated in physiotherapy, exercises that did not require weight bearing, exercises that used passive and active assistance, activities that involved partial and full weight bearing, and exercises that involved complete weight bearing. At the 2-year follow-up, the patient's left knee continued to be painless and stable, and it had unrestricted range of motion across the whole extremity. It was determined via radiographs that the fracture had healed without any problems or arthritic changes developing. She was able to walk without help and carry out her daily tasks since she was able to walk with the use of a cane. Conclusions: Retrograde cannulated screws can be a reliable and successful choice for treatment of medial Hoffa fractures, with positive results according to both clinical and radiographic characteristics. Further research is needed to analyze the outcomes over a longer period of time and make comparisons between this technique and others.
Introduction
Hoffa fractures are challenging coronally-oriented articular injuries of the femoral condyle. These fractures are rare in adults and extremely rare in the skeletally immature, with few cases reported in literature. To prevent mal- or non-union, Hoffa fractures require prompt surgical stabilisation with anatomic reduction and internal fixation.
Case report
We discuss the case of a lateral distal femoral condyle cartilaginous Hoffa fracture in a ten-year-old male patient. The patient presented after a football non-contact “twist and pop” injury with radiographic imaging described as an osteochondritis dissecans lesion. An MRI was obtained which demonstrated a lateral distal femoral condyle osteochondral fracture. An operative plan was formulated to perform arthroscopic reduction and bio-compression screw fixation to minimize damage to the physis and surrounding tissues. Hyperflexion of the knee allowed for anatomic fracture reduction with the placement of 2 bio-compression screws serving as maintenance of fixation. The patient did well postoperatively and returned to full activity after 6 months.
Conclusion
Hoffa fractures in the pediatric population are rare and can occur not only through bone but also through the thick chondral layer in younger patients. These are extremely difficult to diagnose through X-Ray alone. The prompt use of MRI imaging allows for operative fixation in a timely fashion, while an arthroscopic-only approach allows for minimal tissue damage. With an appropriate fracture type, hyper-flexion reduces and stabilizes the fracture, permitting the placement of minimally invasive bio-compression fixation.
Introduction
Hoffa fractures are challenging coronally-oriented articular injuries of the femoral condyle. These fractures are rare in adults and extremely rare in the skeletally immature, with few cases reported in literature. To prevent mal- or non-union, Hoffa fractures require prompt surgical stabilisation with anatomic reduction and internal fixation.
Case Report
We discuss the case of a lateral distal femoral condyle cartilaginous Hoffa fracture in a ten-year-old male patient. The patient presented after a football non-contact “twist and pop” injury with radiographic imaging described as an osteochondritis dissecans lesion. An MRI was obtained which demonstrated a lateral distal femoral condyle cartilaginous fracture. An operative plan was formulated to perform arthroscopic reduction and bio-compression screw fixation to minimize damage to the physis and surrounding tissues. Hyperflexion of the knee allowed for anatomic fracture reduction with the placement of 2 bio-compression screws serving as maintenance of fixation. The patient did well postoperatively and returned to full activity after 6 months.
Conclusion
Hoffa fractures in the pediatric population are rare and can occur not only through bone but also through the thick chondral layer in younger patients. These are extremely difficult to diagnose through X-Ray alone. The prompt use of MRI imaging allows for operative fixation in a timely fashion, while an arthroscopic-only approach allows for minimal tissue damage. With an appropriate fracture type, hyper-flexion reduces and stabilizes the fracture, permitting the placement of minimally invasive bio-compression fixation.
