The April 2024 Trauma Roundup. 360. looks at: The infra-acetabular screw in acetabular fracture surgery; Is skin traction helpful in patients with intertrochanteric hip fractures?; Reducing pain and improving function following hip fracture surgery; Are postoperative splints helpful following ankle fracture fixation?; Biomechanics of internal fixation in Hoffa fractures: a comparison of four different constructs; Dual-plate fixation of periprosthetic distal femur fractures; Do direct oral anticoagulants necessarily mean a delay to hip fracture surgery?; Plate or retrograde nail for low distal femur fractures?

Purpose

Isolated fractures of femoral condyle in the coronal plane (Hoffa fracture) is rare and is surgically challenging to treat. 44 patients were operated between 2004–2014. The aim was to retrospectively assess the fracture patterns, fixation done and functional outcome.

Introduction. Hoffa fractures are rare, intra-articular fractures of the femoral condyle in the coronal plane and involving the weight-bearing surface of the distal femur. Surgical fixation is warranted to achieve stability, early mobilisation and satisfactory knee function. We describe a unique type of Hoffa fracture in the coronal plane with sagittal split and intra-articular comminution. There is scant evidence in current literature with regards to surgical approaches, techniques and implants. We report of our case with a review of the literature. Case report. A 40 year old male motorcyclist was involved in a high speed road traffic collision. X-rays confirmed displaced unicondylar fracture of the lateral femoral condyle. CT showed sagittal split of the Hoffa fragment and intra-articular comminution. MRI showed partial rupture of the anterior cruciate ligament. The patient underwent definitive surgical treatment via a midline skin incision and lateral parapatellar approach using cannulated screws, headless compression screws and anti-glide plate. Weightbearing was commenced at 8 weeks. Arthroscopy and adhesiolysis was performed at 12 weeks to improve range of motion. The patient was discharged at one year with a pain-free, functional knee. Discussion. Hoffa fractures are high-energy fractures, often seen in young male motorcyclists with flexed and slightly abducted knee. Most papers recommend surgical fixation, however there is no widely accepted surgical method or rehabilitation regime. Varying surgical approaches, screw direction, choice of implants, and post-operative care have been described. Surgical approach depends on the configuration of the fracture. The medial/lateral parapatellar approach is commonly used as it does not compromise future arthroplasty, but it does not allow access to fix posterior comminution. Arthroscopic-assistance may be used with good outcomes and less tissue dissection. AP screws are widely reported in the literature, most likely due to easier access to the fracture site. PA screws may provide better stability, but access is more difficult. Fixation often involves passing screws through the articular surface, therefore the area damaged should be kept to a minimum by using the smallest possible screw; headless compression screws leave a smaller footprint in the articular cartilage. Locking plate augmentation generally gives good outcomes. Conclusion. Hoffa fractures are rare and difficult to treat. Surgical treatment is the best choice for optimum post-operative knee function. There is no consensus on choice of surgical approaches, techniques and implants, as these are dependent on fracture configuration. In this particular case we emphasise the importance of using an anti-glide plate to address the sagittal component. Despite the need for a secondary procedure, the treatment has had positive outcomes and may be used as a guide for treatment of future Hoffa fractures of a similar sub-type

Coronal plane fractures of the posterior femoral condyle, also known as Hoffa fractures, are rare. Lateral fractures are three times more common than medial fractures, although the reason for this is not clear. The exact mechanism of injury is likely to be a vertical shear force on the posterior femoral condyle with varying degrees of knee flexion. These fractures are commonly associated with high-energy trauma and are a diagnostic and surgical challenge. Hoffa fractures are often associated with inter- or supracondylar distal femoral fractures and CT scans are useful in delineating the coronal shear component, which can easily be missed. There are few recommendations in the literature regarding the surgical approach and methods of fixation that may be used for this injury. Non-operative treatment has been associated with poor outcomes. The goals of treatment are anatomical reduction of the articular surface with rigid, stable fixation to allow early mobilisation in order to restore function. A surgical approach that allows access to the posterior aspect of the femoral condyle is described and the use of postero-anterior lag screws with or without an additional buttress plate for fixation of these difficult fractures. Cite this article: Bone Joint J 2013;95-B:1165–71