Foundation of Diagnosing and Treating a Hoffa Fracture

Abstract

Introduction: Hoffa fractures are a rare type of intra-articular fracture characterized by disruption in the coronal plane. They are challenging to diagnose because of the orientation of the fracture and the common radiography views used to evaluate knee pain. Methods: A literature review search was obtained with PubMed. Primary and secondary sources were included. Results: Hoffa fractures are typically found after highly traumatic events such as motor vehicle accidents or falls from great heights. Hoffa fractures are classified by the Letenneur system, which categorizes fractures into 1 of 3 types. Hoffa fractures typically go undiagnosed on typical radiographs, so CT scans are necessary for proper diagnosis. Physical symptoms can include trouble walking, swelling, and periarticular pain. Conservative treatment is not favorable compared with surgical reduction and fixation. Postop care and rehabilitation can affect the outcome of the surgery and should be closely monitored. Discussion: Hoffa fractures often go unnoticed because traumas result in other injuries and might overlook a fracture that is not detected on radiographs especially traditional anteroposterior (AP) or posteroanterior (PA) views. Once they are diagnosed, they are difficult to manage conservatively because these fractures have a slow healing process and may lead to nonunion of the femur. Surgical treatment is the most reliable option regarding healing and returning to normal weight-bearing and activities. Conclusion: Hoffa fractures are fractures involving the femoral condyle in the coronal plane, which are more rare than fractures in the sagittal plane and therefore commonly missed. This type of fracture is complicated to assess and treat because of its positioning and is easily missed on standard AP/PA radiographs. Surgical intervention is the best option to ensure the best outcomes.