AJR 2002; 178:994
© American Roentgen Ray Society
Trauma Cases from Harborview Medical Center |
Hoffa Fracture
A Common Association with High-Energy Supracondylar Fractures of the Distal Femur
Brent J. Baker1,
Eva M. Escobedo1,
Sean E. Nork2 and
M. Bradford Henley2
1
Department of Radiology, University of Washington School of Medicine,
Harborview Medical Center, 325 Ninth Ave., Box 359728, Seattle, WA
98104-2499.
2
Department of Orthopaedic Surgery, University of Washington School of
Medicine, Harborview Medical Center, Seattle, WA 98104-2499.
Received June 22, 2001;
accepted after revision July 2, 2001.
This is another in the continuing series on radiology in trauma cases from
the Harborview Medical Center. Editors: Fred A. Mann, Eric J. Stern, and Lee
B. Talner.
Address correspondence to F.A. Mann.
Introduction
A 37-year-old female pedestrian who had been hit by a car sustained a
comminuted supracondylar fracture of the left distal femur with an
intercondylar extension. On initial review of the patient's radiographs, a
minimal step-off of the anterior cortex of the lateral femoral condyle was not
seen (Figs. 1A and
1B). CT more clearly delineated
a coronal plane fracture of the lateral condyle and the extension of the
intercondylar fracture (Fig.
1C).
View larger version (130K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1A. —37-year-old woman who had been hit by automobile while
walking. Anteroposterior radiograph shows comminuted supracondylar and
intercondylar fracture of distal femur with medial displacement and overriding
femoral shaft (arrows).
|
|
View larger version (143K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1C. —37-year-old woman who had been hit by automobile while
walking. Axial CT scan acquired with 1-mm collimation shows coronally oriented
fracture (arrows) through lateral femoral condyle.
|
|
The imaging evaluation of distal femoral fractures is based primarily on
conventional radiographs. Supracondylar distal femoral fractures may be
classified as extraarticular, unicondylar, or bicondylar, and the fractures
may have an intercondylar extension
[1,
2]. About 40% of intercondylar
fractures have an associated coronal plane, or a "Hoffa,"
fracture, (Nork SE, unpublished data) which is a marker of high-energy blunt
trauma [3,
4]. Although occasionally
bicondylar, the Hoffa fragments are more commonly unicondylar and usually
originate from the lateral femoral condyle
[3,
4]. Overall, Hoffa fractures
are rare [1,
4], and, considering the plane
and location of fracture, it is not surprising that they are often overlooked
on conventional radiographs
[3].
Because these injuries result from high-energy trauma, one should also
exclude other associated injuries of the pelvis and hip (acetabular fractures,
femoral neck and shaft fractures, and posterior hip dislocations), patella and
tibial plateau fractures, popliteal vessel injuries, and ligamentous
disruptions of the knee [1,
2].
Patients with distal femoral fractures do not routinely require CT.
However, the presence of a supracondylar fracture with intraarticular
extension suggests that there may be an occult associated coronal-plane Hoffa
fracture. In our experience, CT is extremely helpful in characterization of
complex intraarticular fractures of the distal femur. Twenty-five percent of
Hoffa's fractures associated with supracondylar femur fractures are not
diagnosed in patients in whom only conventional radiographs are obtained (Nork
SE, unpublished data).
Preoperative recognition of an associated Hoffa fracture affects surgical
planning. Fragment displacement may occur during placement of an angled blade
plate or its seating chisel, and if unrecognized, postoperative displacement
may necessitate a second surgery
[3]. In our experience, more
than half of radiographically occult Hoffa fragments required an
intraoperative change in the hardware selection and technique for
fixation.
References
-
Rogers LF. The hip and femoral shaft. In: Rogers LF, ed.
Radiology of skeletal trauma, 2nd ed. New York:
Churchill Livingstone, 1992:1199
-1317
-
Helfet DL. Fractures of the distal femur. In: Browner BD, Jupiter
JB, Levine AM, Trafton PG, eds. Skeletal trauma.
Philadelphia: Saunders, 1992:1643
-1683
-
Lewis S, Pozo J, Muirhead-Allwood W. Coronal fractures of the
lateral femoral condyle. J Bone Joint Surg Br
1989;71:118
-120
-
Letenneur J, Labour PE, Rogez JM, Lignon J, Bainvel JV. Hoffa's
fractures: report of 20 cases. Ann Chir
1978;32:213
-219[Medline]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
R. Miyamoto, E. Fornari, and N. C. Tejwani
Hoffa Fragment Associated with a Femoral Shaft Fracture. A Case Report
J. Bone Joint Surg. Am.,
October 1, 2006;
88(10):
2270 - 2274.
[Full Text]
[PDF]
|
|
|
Top
Introduction
References
