Hoffa Fracture Non-union Treated with Medial Parapatellar Approach and Headless Compression Screw Fixation: A Case Report
Year: 2026
Type: article
Abstract: Introduction: Isolated coronal fractures of the femoral condyle (Hoffa fractures) are rare, and non-union of a Hoffa fracture is rarer still. Non-union typically results from a missed diagnosis on initial radiographs or from non-operative management of a displaced fracture, and its surgical correction is technically demanding because of fibrous interposition at the fracture site, sclerosis of the fragment margins, and a stiff, contracted joint. Case Report: A 45-year-old male presented 3 months after a road traffic accident with direct trauma to the knee, having been treated elsewhere with an above-knee slab and no surgical fixation. He presented with a fixed flexion deformity of 30°, further flexion to 90°, diffuse tenderness and swelling, and radiographic non-union of a posterior (coronal) Hoffa fracture of the femoral condyle. He underwent open debridement of the fibrous non-union interface through a medial parapatellar arthrotomy, anatomical reduction under fluoroscopic guidance, and fixation with two parallel headless compression screws placed perpendicular to the coronal fracture plane. Postoperatively, the knee was kept non-weight-bearing, with bedside range-of-motion exercises graduated from 0-30° for the first 10 days to 0-60° for the next 10 days and to 0-90° over the following 10 days, with full knee extension achieved throughout. Partial weight-bearing was started and continued for 1 month, followed by progression to full weight-bearing. At the final follow-up, the patient had regained knee flexion to 100°, with the pre-operative 30° extension lag improving to 10°, and only occasional mild pain (3/10); he returned to sedentary, desk-based activity. No post-operative complications occurred, though the chronicity of the non-union made intraoperative reduction technically demanding, owing to severe periarticular fibrosis and secondary hamstring contracture. Conclusion: Successful reconstruction of a neglected Hoffa non-union depends less on the implant chosen than on the surgical sequence: Adequate exposure of the posterior condyle, thorough debridement of fibrous and sclerotic bone without sacrificing articular congruity, confirmation of screw trajectory on more than one fluoroscopic plane, and staged management of the associated flexion contracture. These technical points, illustrated in this case, are transferable to other neglected coronal shear fractures around the knee.
Authors: Sahil Chowdhary, Amit Dhond, Himanshu Bharti
Institution: Brihanmumbai Municipal Corporation
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $250
OpenAlex ID: W7225587518