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Surgically treated Hoffa Fractures with poor long-term functional results
Tolga Onay1, Deniz Gülabi2, İlker Çolak2
1Marmara University, Pendik Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
Insights
Surgically treated Hoffa fractures, rare posterior femoral condyle injuries, showed good healing but frequent long-term osteoarthritis. Medial Hoffa fractures had poorer outcomes than lateral ones.
Area of Science:
- Orthopedic surgery
- Traumatology
- Radiology
Background:
- Hoffa fractures, rare injuries typically involving the lateral femoral condyle, have limited large-scale outcome studies.
- This study focuses on isolated coronal plane fractures of the distal femur posterior condyle.
Purpose of the Study:
- To determine the long-term functional outcomes and complications of surgically treated Hoffa fractures.
- To compare outcomes between medial and lateral Hoffa fracture types.
Main Methods:
- Retrospective review of 13 surgically treated patients with isolated coronal plane distal femur posterior condyle fractures.
- Evaluation included physical examination, radiographs, CT, Oxford knee scoring, Knee Society Score (KSS), and Visual Analog Scale (VAS).
Main Results:
- Mean follow-up was 93 months; mean healing time was 10 weeks.
- Average ROM was 110°, mean KSS 78.4, mean Oxford score 38.2.
- Osteoarthritis occurred in 54% of patients, avascular necrosis in 15.4%. Medial Hoffa fractures showed worse functional results (lower KSS and Oxford scores) than lateral fractures.
Conclusions:
- Hoffa fractures can be easily missed on initial radiological examination.
- Screw fixation provides adequate biomechanical stability for fracture healing.
- Arthrosis is a common long-term complication impacting functional results, with medial fractures faring worse.
Introduction:
Hoffa fractures are rare injuries and usually involve the lateral condyle. There are few published studies of large series of isolated coronal plane fractures of the femoral condyle. The aim of the study to determine the long-term functional outcomes and complications in surgically treated Hoffa fractures.
Patients And Methods:
A retrospective review was made of 13 consecutive patients who were treated surgically for an isolated coronal plane fracture of the distal femur posterior condyle. The patients were evaluated with physical examination, PA and lateral radiographs and CT at the final follow-up examination. Functional outcome was evaluated with the OXFORD knee scoring system and Knee Society Score (KSS). Pain at rest and in activity was assessed using a Visual Analog Scale (VAS).
Results:
The patients comprised 11 males and 2 females with an average age at surgery of 27.5 years. The mean follow-up period was 93 months (range, 62-134 months). Mean time to fracture healing was 10 weeks (range, 8-12 weeks). The mean ROM was determined as 110°, mean KSS 78,4 and mean Oxford knee score 38,2. The mean KSS was 66,5 for medial Hoffa fracture patients and it was 83,8 for lateral Hoffa fracture patients. The mean Oxford knee score was 33,2 for medial Hoffa fracture patients and it was 40,4 for lateral Hoffa fracture patients. The mean VAS at rest and in activity was 1,1 and 2,9, respectively. Osteoarthritis was seen in 7 (54%) patients and avascular necrosis in 2 (15.4%). Varus instability was determined in 1 patient and valgus instability in 1 patient.
Conclusion:
Hoffa fractures may easily be overlooked if the radiological examination is not made carefully. Screw fixation was seen to provide enough biomechanical stability until the fracture healed. Arthrosis is a frequent long-term complication which worsens the functional results. Medial Hoffa fractures tend to have worse functional results than lateral Hoffa fractures.
Level Of Evidence:
Therapeutic Level IV retrospective case series.
