Surgical management of complex intra-articular distal femoral and bicondylar Hoffa fracture

Abstract

Bicondylar Hoffa's fractures of distal femur are rare. We report the case of an 18-year-old male who sustained a closed complex fracture of both femoral condyles of the left femur on the sagittal plane (Hoffa fracture), combined with distal metaphyseal fracture. He was treated using parallel plates and interdigitating screws, with our technique based on an extrapolation of the principles of distal humerus fixation. The fracture united clinically and radiologically at 16 weeks. Twelve months postoperatively, the range of movement in the knee was 5°-115°. In this complex case, our technique provided stable fixation of the fragments and a satisfactory final functional outcome.

Open complex distal femur intraarticular fracture with Hoffa extension, extensor mechanism tear and post-recovery secondary traumatic peri implant fracture: report on an uncommon chronology

“…The standard method of treating Hoffa fractures has been lag screw fixation. 7 Lag screws directed from posterior to anterior offer a mechanical advantage over screws placed from anterior to posterior. 6 Partially threaded cancellous or headless screws of 6.5 mm or 4 mm in length supplemented by an anti-glide/buttress plate in osteoporotic bones or screws inserted just proximal to the Hoffa's fragment to buttress it against a shearing stress are the options the operating surgeon may avail.…”

“…Second, a plate of adequate length to act as a buttress plate would be required, compromising part of the posterior articular surface of the condyles. 7 Creating a solid construct with anatomic reduction and compressive fixation in accordance with the AO principles of fixation of intra-articular fractures is advocated. 7 However, due to nature of the soft tissue injury in our case and associated comminuted metaphyseal distal femur fracture with loss of bony fragments, a biological fixation principle was used.…”

“…7 Creating a solid construct with anatomic reduction and compressive fixation in accordance with the AO principles of fixation of intra-articular fractures is advocated. 7 However, due to nature of the soft tissue injury in our case and associated comminuted metaphyseal distal femur fracture with loss of bony fragments, a biological fixation principle was used. Hoffa fracture fixation was supplemented by bridging of fracture with locked distal femoral plate for proper limb alignment, length and additional grafting procedure was done for defect augmentation.…”

“…[1][2][3][4][5] Hoffa's fracture may involve either of the femoral condyle but is more common on the lateral side because of natural knee valgus orientation. 6,7 Open fractures with associated injuries of tibial spine, extensor tendon rupture have been reported rarely. [5][6][7][8] Functional outcomes are compromised commonly due to infection, stiffness, nonunion and delayed rehabilitation.…”

“…6,7 Open fractures with associated injuries of tibial spine, extensor tendon rupture have been reported rarely. [5][6][7][8] Functional outcomes are compromised commonly due to infection, stiffness, nonunion and delayed rehabilitation.…”