Operative management of Hoffa fractures--a prospective review of 18 patients

Hoffa fractures represent coronal fractures of the femoral condyles. Isolated Hoffa fractures are rare and current management of these fractures is based on a few descriptions in literature. The goal of the study was to prospectively analyse the clinico-radiological and functional outcome following open surgical treatment.

A total of 18 isolated Hoffa fractures were identified during the study period spanning 29 months. All fractures were treated by open reduction through a medial parapatellar approach. Internal fixation was performed with screws in the anteroposterior/posteroanterior (AP/PA) direction. Immediate active mobilisation with restricted weight bearing was instituted postoperatively. Radiological and functional outcome analysis using Knee Society scores and International Knee Documentation Committee scores were performed at follow-up visits until 1 year.

Union was achieved in all patients. The articular surface was reduced anatomically in all but one patient. There was no loss of reduction or fixation. Functional outcome measures showed a continuous significant improvement in function over the 1-year follow up period. Complications include stiffness and pain in one patient, collateral laxity in two patients and progression of arthritis in one patient.

Hoffa fractures are intra-articular and are best treated by anatomical reduction and rigid fixation followed by early mobilisation. Open reduction increases the chances of achieving anatomical reduction and gives satisfactory functional results when coupled with aggressive rehabilitation.