Abstract

An isolated fracture of the distal femoral condyle in the coronal plane is a rare injury described first by Hoffa in 1904. This injury is an intra-articular fracture of the knee that corresponds to the OTA classification of 33-B3. The mechanism of trauma has been described as direct with abduction and axial compression on a flexed knee through the tibial plateau concentrating the force in the posterior half of the femoral condyles.

The reports in the literature show poor outcomes with non-operative treatment which includes knee instability and rapid development of post traumatic osteoarthritis. Operative treatment consisting of an open or mini open arthrotomy has become the most popular method for fixation. It was our goal to develop a reliable arthroscopic technique to avoid the complications associated with an open arthrotomy.

A Hoffa fracture pattern was created with osteotomes in two cadaveric knees. Arthroscopy was performed allowing visualization of fracture. A Schanz pin was then placed into the lateral femoral condyle and the fracture was reduced. An ACL guide was then introduced through a medial portal to aid in fracture reduction and provide compression across the condyle. Guide pins were placed through the ACL guide, followed by two cannulated 6.5 mm cancellous screws. Fluoroscopy was then used during the procedure to ensure adequate reduction and fixation of the coronal fracture. The described technique permitted adequate evaluation, reduction and secure fixation of coronal fractures of femoral condyles through a minimally invasive arthroscopic assisted procedure.