A computed tomography-based classification of Hoffa fracture: Surgical treatment considerations and prognostic outcome with assessment of reproducibility

• Published in: Journal of orthopaedics 2020-07, Vol.20, p.21-27
• Main Authors: Chandrabose, Rex, Saha, Sayantan, Kumar, Harish, Tapadiya, Niraj, HD, Bharath
• Format: Article
• Language: English
• Subjects: Classification; Coronal plane fracture; Femur; Fixation protocols; Hoffa fracture
• ISSN: 0972-978X; 0972-978X
• DOI: 10.1016/j.jor.2019.12.011

Isolated fracture of femoral condyle in the coronal plane (Hoffa fracture) is rare and surgically challenging to treat. The purpose of this study is to introduce a new classification for this fracture, evaluating its utility in treatment guidelines and its reproducibility. 103 patients with Hoffa fracture were operated in our tertiary care centre from 2004 to 2014. Computed tomography (CT) was done in all cases preoperatively. Many fractures had variable patterns which could not be defined and categorized as per Letennuer's classification. A pilot study with first 25 cases were analysed and certain morphological fracture patterns were observed in CT. The fixation methods and failure models were also noted. This resulted in development of a new classification specifying the fracture patterns and the preferred fixation methods for a better outcome. Next 78 consecutive fractures were then classified preoperatively as per our CT classification and treatment executed according to the protocol. Outcomes were measured using Neer's scoring system and International Knee Society Documentation Committee (IKDC) Functional Score. Out of 78 patients, 69 had excellent outcome, 7 had satisfactory and 2 had unsatisfactory outcome which corresponded with the specified fracture severity pattern. Uniformly excellent results were obtained in all simple pattern fractures, whereas comminuted fractures especially posterior cortex comminution and articular comminution yielded less favourable outcomes. We conclude that therapeutic outcome is significantly affected by articular comminution, posterior cortex comminution, achieving anatomical reduction and stable fixation. Pre-operative fracture classification and treatment guidelines gives a predictable outcome with least complications and has good interobserver reliability thus instrumental in surgical planning. III.