Complexities in Hoffa Fracture Management: A Case Report on Diagnosis and Fixation Technique

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Radiology

Background:

• Hoffa fractures are rare (0.65% of femoral fractures) distal femur injuries, often affecting the lateral condyle.
• These fractures are frequently overlooked on standard radiographs, necessitating advanced imaging like CT for diagnosis.
• Existing classification systems may not fully capture the unique patterns of Hoffa fractures, posing treatment challenges.

Purpose of the Study:

• To present a case of a complex Hoffa fracture with a unique pattern.
• To describe the surgical management and outcomes of this rare fracture type.
• To emphasize the importance of advanced imaging and tailored surgical approaches for Hoffa fractures.

Main Methods:

• Diagnosis of a coronal split Hoffa fracture of the lateral femoral condyle via CT scan.
• Surgical fixation utilizing a posterolateral approach with posterior-to-anterior lag screws.
• Postoperative management included a non-weight-bearing regimen and structured rehabilitation exercises.

Main Results:

• The patient achieved significant improvement in knee range of motion (ROM), increasing from 25° to 125° flexion at 6 months.
• Excellent functional outcomes were noted, with the Neer score improving from 30 to 90.
• Statistical analysis showed significant improvements in both ROM (p=0.0144) and Neer score (p=0.0077).

Conclusions:

• Hoffa fractures require careful diagnosis, often necessitating CT scans due to subtle radiographic findings.
• A posterolateral approach and posterior-to-anterior lag screw fixation can effectively manage complex Hoffa fractures.
• Anatomical reduction and early mobilization are key to optimizing functional recovery in patients with Hoffa fractures.