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

Hoffa fractures, accounting for 0.65% of femoral fractures, are rare injuries to the distal femur, typically affecting the lateral condyle. These fractures are often overlooked in radiographs and pose challenges in classification, as traditional systems like Letenneur's may not adequately address certain unique fracture patterns, as seen in the present case.

A 25-year-old male with trauma to the left knee and pelvis was diagnosed with a pelvic open-book injury and a coronal split Hoffa fracture of the lateral femoral condyle. Surgical fixation involved external fixation for the pelvis and a posterolateral approach for the knee fracture, followed by a nonweight-bearing regimen and rehabilitation exercises.

The patient showed significant improvement in both range of motion (ROM) and functional outcomes over follow-up visits. Flexion increased from 25° preoperatively to 125° at 6 months, and the Neer score improved from 30 to 90, indicating an excellent outcome (p value-0.0077 for Neer score, 0.0144 for ROM).

Hoffa fractures are often missed on standard radiographs and require CT for accurate diagnosis. Existing classification systems offer limited guidance, as these fractures can present with varied patterns. In our case, a unique fracture pattern necessitated a posterolateral approach with lag screws from posterior to anterior, ensuring a proper reduction and fixation, in line with the principles of anatomical reduction and early mobilization.

Hoffa fractures are challenging to diagnose and treat due to their atypical patterns. Preoperative CT planning and flexible surgical approaches, such as our use of posterior-to-anterior lag screws, are crucial. Focusing on anatomical reduction and early mobilization can optimize recovery, with further research needed to refine classifications and improve outcomes.