Hoffa Fragment Associated with a Femoral Shaft Fracture: A Case Report

Abstract

A coronal plane fracture of the femoral condyle (creating a so-called Hoffa fragment) has been well described in association with fractures of the supracondylar-intercondylar region of the distal part of the femur1. This fracture has implications with regard to preoperative planning, the choice of surgical approach, implant selection, and functional outcomes. Coronal plane fractures of the distal part of the femur are markers of high-energy injury mechanisms. Their presence warrants a thorough workup for other injuries associated with high-energy trauma such as fractures of the spine, pelvis, femoral neck, tibial plateau, ankle, and calcaneus. A Hoffa fracture can often be missed on plain radiographs. Nork et al. showed that up to 30% of coronal plane fractures were missed on plain radiographs of distal femoral fractures, often necessitating the use of computerized tomography for identification and preoperative planning2. While the association of a Hoffa fragment with a supracondylar-intercondylar femoral fracture has been well characterized, we are unaware of any previous reports on the isolated occurrence of a coronal plane fracture of a femoral condyle in association with an ipsilateral femoral shaft fracture. We report on a patient who sustained a femoral shaft fracture with an ipsilateral coronal plane fracture of the medial femoral condyle. The patient was informed that data concerning the case would be submitted for publication. A thirty-three-year-old right-hand-dominant man was riding a motorcycle when he was struck by a tractor trailer. He was immediately transported to a level-I trauma center, where he described severe pain in the left leg and arm. Gross deformities of the left arm and thigh were identified on physical examination. Both injuries were closed, and both extremities were neurovascularly intact. A transverse fracture of the left humerus was treated with a coaptation splint. A small effusion was present in the …