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. 2019:5:18.
doi: 10.1051/sicotj/2019016. Epub 2019 Jun 7.

A proposed radiological classification system of Hoffa's fracture based on fracture configuration and consequent optimal treatment strategy along with the review of literature

Vaibhav Bagaria  1 , Gaurav Sharma  2 , Chaitanya Waghchoure  2 , Rajendra M Chandak  3 , Amit Nemade  4 , Kalyan Tadepelli  2 , Prashant Pawar  2
Affiliations

A proposed radiological classification system of Hoffa's fracture based on fracture configuration and consequent optimal treatment strategy along with the review of literature

Vaibhav Bagaria et al. SICOT J. 2019.

Abstract

Background: Coronal fractures of distal end femur, referred as Hoffa's fracture are not uncommon, yet easily missed injuries lacking proper classification system and consensus for ideal treatment. While most trauma surgeons adopt different strategies based on the fracture configuration and their own experience, there are no set ways to classify these based on the most appropriate treatment strategy.

Methods: Thirty cases of Hoffa fracture from tertiary care centres were studied for the fracture pattern, fragment size, comminution and possible variations to formulate a radiological classification and treatment guidelines. Additionally, a literature search was used to analyze 77 case studies based on Hoffa fracture to find out the common fracture patterns and treatment modalities adopted for varying fracture patterns in these studies. Six independent observers participated in testing the inter-observer reliability of the proposed classification.

Results: A new proposed radiological classification for Hoffa fracture consists of four main types. Type 1 is with fracture fragment >2.5 cm, Type 2 with fragment <2.5 cm, Type 3 is comminuted fracture, Type 4 are subdivided as Type 4a - Anterior, Type 4b - Bicondylar, Type 4c - Osteochondral type and Type 4d - With supracondylar extension. Optimum treatment modality depends on the type of Hoffa's fracture and has been suggested in the study. Interobserver reliability demonstrated that overall agreement was 0.907692 with a fixed marginal Kappa of 0.881067 and free Marginal Kappa at 0.892308. Intra-observer reliability test for the classification system showed a strong Kappa value of +1.0.

Conclusion: The new suggested classification helps identify different types of Hoffa's fracture. This is likely to help decide optimal surgical treatment depending on the nature of the injury. The classification system has high inter and intra-observer reliability that enables its universal applicability.

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Figures

Figure 1
Figure 1
Flow chart to selection process.
Figure 2
Figure 2
Sagittal View of various fracture configurations of Hoffa’s fracture as per the proposed classification system.
Figure 3
Figure 3
Radiological images as per the new classification system.
Figure 4
Figure 4
Axial View of various fracture configurations of Hoffa’s fracture as per the proposed classification system. Type 1 – unicondylar fracture with fragment size > 2.5 cm, Type 2 – unicondylar fracture with fragment size < 2.5 cm, Type 3 – comminuted fracture, Type 4a – anterior lip Hoffa’s fracture, Type 4b – bicondylar fracture, Type 4c – marginal osteochondral fracture, Type 4d – with associated supracondylar fracture.
Figure 5
Figure 5
(a) Reduction of Type I Hoffa’s with AP lag screw. (b) Improper reduction of Type II Hoffa’s with AP lag screw leading to distraction at the fracture site (indicated by blue arrows).
See this image and copyright information in PMC

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