Hoffa Fractures: Current Understanding and Surgical Treatment Strategies

Coronal fractures of the distal femur, although uncommon in isolation, represent a distinct fracture pattern different from other distal femur fracture subtypes. Popularly known as the Hoffa fractures, these injuries are characterized by obliquely oriented fracture lines in the coronal plane with or without articular comminution. These partial articular fractures are commonly seen on the lateral condyle as a result of translational shearing forces on the posterior femoral condyle with the knee in flexion. These fractures were often missed before the advent of routine use of CT scans because they appear subtle on plain radiographs. The frequent presence of major and more proximal associated skeletal injuries is another reason that these fractures may be missed in the initial evaluation. Hoffa fractures, being articular injuries, need anatomical reduction and a stable fixation to facilitate early knee motion and prevent arthrofibrosis. Surgical treatment of these fractures needs a careful understanding of various fracture patterns, presence of comminution, articular impaction, fragment size, and location to choose the optimal surgical approach, reduction, and fixation techniques. This review will outline strategies for surgical management of Hoffa fractures and discuss outcomes and complications based on published evidence.