Medial Hoffa Fracture: Description of a Novel Classification System and Rationale for Treatment Based on Fragment-Specific Fixation Strategy

Abstract

Purpose This study aims to present a novel classification system and a rationale for treatment of medial Hoffa fractures. Methods We developed a simple comprehensive classification system for medial Hoffa fractures based on the fragment size and presence of fracture comminution. Furthermore, we propose a treatment algorithm based on two pillars: our case series of nine patients presenting medial Hoffa fractures and the best evidence-based pertinent literature. Fracture healing, range of motion, function, and complications were evaluated after a minimum of 6 months follow-up. Results All fractures healed with no loss of reduction. Knee flexion ranged from 90 – 130° (mean 110°, standard deviation 15.2). Knee extension ranged from 0 – 10° (mean 1°, standard deviation 3.3). Knee function according to the Lysholm score ranged from 74 – 96 points (mean 85, standard deviation 6.3). There were no complications such as infection, fixation failure, or medial femoral condyle osteonecrosis. One patient required hardware removal due to soft tissue irritation and one patient underwent knee mobilization under anesthesia after 8 weeks of fracture fixation due to knee stiffness. Conclusion The presented rationale for treatment based on the new classification system is a simple and effective strategy on the decision-making process for adequate management of medial Hoffa fractures.

Busch-Hoffa fracture: A systematic review

“…As above mentioned, lateral Busch-Hoffa fractures present different morphology and characteristics from medial fractures. Therefore, Pires et al [ 17 ] proposed a new classification system especially developed for coronal plane fractures of the medial condyle, based on the size of the fractured fragment and the presence of comminution (Fig. 3 ).…”

“…[16] Figure 2 illustrates the types of fracture according to the Letenneur classification. Pires et al [17] proposed a modification to the original Letenneur classification, adding a variant pattern characterized by the presence of a type I fracture associated with a comminution zone or an intercalary fragment, which produces joint depression in the weight bearing zone of the femoral condyle. This modification of the original classification is supported by the mapping study of 74 distal fractures of the femur in the coronal plane carried out by Xie et al [5] The authors reported that central comminution (intercalary fragment) was present in 44.9% of coronal fractures of the lateral condyle.…”

“…Singh et al, [40] observing the treatment of 6 patients where 3 had fixation failures, [11] Figure 3. Classification of medial femoral condyle fractures in the coronal plane, according to Pires et al, [17] highlighted the difficulty of reconstructive for this type of fracture. The study of Trikha et al [8] compiles a review of 32 patients, all treated with open reduction and internal fixation, using lateral approach to address lateral and a medial approach to address medial Busch-Hoffa fractures.…”

“…Figure3. Classification of medial femoral condyle fractures in the coronal plane, according to Pires et al,[17] adapted-c = comminution.…”