Fracture Femur Hoffa Fracture

 

Hoffa fracture is a coronal split of the posterior condyle of the femur. Hoffa fracture is a rare intra-articular fracture of the posterior femoral condyle occurring from violent trauma, and generally occurs in young adults. Three types of Hoffa fractures are described. This classification is based on the location of the fracture within the condyle. Hoffa fracture can be an isolated fracture; however, it is often associated with other distal femur fractures. 38% of intra-articular distal femur fractures may have a Hoffa fracture (coronal plane fracture). The Hoffa fracture is a lot more common in open fractures than in closed fractures. Fracture may occur in either condyle, but the lateral condyle is the most common one to be affected by Hoffa fracture. It affects a single condyle in about 75% of the time, and the lateral condyle in about 85% of the time. Hoffa fracture occurs due to axial compression in a flexed knee. The mechanism of injury is controversial. The fracture is coronal, and it can be missed on routine lateral x-rays. The undisplaced fracture of the condyle may become displaced if the fracture is missed. The Hoffa fracture is almost like the capitellar fracture of the elbow. This fracture has the same story as the capitellar fracture, it is hidden, and you can miss it on the x-ray (you must look for it). CT scan is very helpful in the diagnosis of Hoffa fracture and will give you great details about the articular surface of the distal femur, especially if the fracture is comminuted. X-rays are not very good in diagnosing the Hoffa fracture. 20% of Hoffa fractures are diagnosed with x-rays only, so the CT scan is the best study for diagnosing the Hoffa fracture. Use a high degree of suspicion in the diagnosis of this fracture because the fracture may be subtle, and you may not be able to see it on routine x-rays. Treatment is reduction and stabilization of the fracture. stabilization of the fragment is usually done by headless compression screws and can be buried underneath the surface. Fixation can be done from either the anteroposterior (AP) direction or the posteroanterior (PA) direction. It can be temporarily fixed with k-wires. Permanent fixation is done with headless compression screws.