Hoffa Nonunion, Two Cases Treated with Headless Compression Screws

Abstract

A coronal fracture of the distal femoral condyle is a rare entity and a nonunion even more so. The coronal fractures, also known as Hoffa fracture, more often involve the lateral than the medial condyle. Open reduction and internal fixation are the primary treatment of choice. We describe two cases of nonunion of a Hoffa fracture (one medial and one lateral). Although the nonunion fragment was not attached to any soft tissues in both cases the fragment was noted to be vital both clinically and histologically. After operative treatment, consisting of debridement, compression with use of headless screws, and liberal use of bone graft both nonunions healed. At latest follow-up, both patients had excellent function and reported no or minimal pain.

Keywords

orthopedics - trauma

• References

• 1 Hoffa A. Lehrbuch der Frakturen und Luxationen. 4th ed. Stuttgart, Germany: Ferdinan Enke Verlag; 1904: 453
• 2 Lewis SL, Pozo JL, Muirhead-Allwood WF. Coronal fractures of the lateral femoral condyle. J Bone Joint Surg Br 1989; 71 (1) 118-120
• 3 Holmes SM, Bomback D, Baumgaertner MR. Coronal fractures of the femoral condyle: a brief report of five cases. J Orthop Trauma 2004; 18 (5) 316-319
• 4 Kumar R, Malhotra R. The Hoffa fracture: Three case reports. J Orthop Surg (Hong Kong) 2001; 9 (2) 47-51
• 5 Letenneur J, Labour PE, Rogez JM, Lignon J, Bainvel JV. Hoffa's fractures. Report of 20 cases (author's transl). Ann Chir 1978; 32 (3-4) 213-219
• 6 McDonough PW, Bernstein RM. Nonunion of a Hoffa fracture in a child. J Orthop Trauma 2000; 14 (7) 519-521
• 7 Meyer C, Enns P, Alt V, Pavlidis T, Kilian O, Schnettler R. Difficulties involved in the Hoffa fractures. Unfallchirurg 2004; 107 (1) 15-21
• 8 Oztürk A, Ozkan Y, Ozdemir RM. Nonunion of a Hoffa fracture in an adult. Chir Organi Mov 2009; 93 (3) 183-185
• 9 Heuschen UA, Göhring U, Meeder PJ. Bilateral Hoffa fracture—a rarity. Aktuelle Traumatol 1994; 24 (3) 83-86
• 10 Payne R, Clark D, Wall S. Union after delayed presentation of a Hoffa fracture. Inj Extra 2005; 36 (7) 289-291
• 11 Manfredini M, Gildone A, Ferrante R, Bernasconi S, Massari L. Unicondylar femoral fractures: therapeutic strategy and long-term results. A review of 23 patients. Acta Orthop Belg 2001; 67 (2) 132-138
• 12 McCarthy JJ, Parker RD. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. Arthroscopy 1996; 12 (2) 224-227
• 13 Smith EJ, Crichlow TP, Roberts PH. Monocondylar fractures of the femur: a review of 13 patients. Injury 1989; 20 (6) 371-374
• 14 Liebergall M, Wilber JH, Mosheiff R, Segal D. Gerdy's tubercle osteotomy for the treatment of coronal fractures of the lateral femoral condyle. J Orthop Trauma 2000; 14 (3) 214-215
• 15 Hak DJ, Nguyen J, Curtiss S, Hazelwood S. Coronal fractures of the distal femoral condyle: a biomechanical evaluation of four internal fixation constructs. Injury 2005; 36 (9) 1103-1106
• 16 Jarit GJ, Kummer FJ, Gibber MJ, Egol KA. A mechanical evaluation of two fixation methods using cancellous screws for coronal fractures of the lateral condyle of the distal femur (OTA type 33B). J Orthop Trauma 2006; 20 (4) 273-276