Intra-articular osteotomy for correction of neglected malunion of medial femoral condyle Hoffa's fracture

Abstract

Hoffa fractures are distal coronal femoral fractures which are intra-articular and involve one or both of the condyles. The lateral condyle is three times more likely to sustain an injury than the medial condyle. Malunion is one of the late complications in neglected instances or following nonoperative management. Medial femoral condyle injuries are quite uncommon. In this case study, a 23-year-old male with a neglected medial Hoffa's malunion is discussed. The patient presented with pain, deformity, and restriction of movements in the left knee for 6 months. Pain aggravates walking and was affecting his daily activities. He allegedly had a past trauma 18 months back for which he took osteopathic treatment. On examination, fixed 10° varus knee deformity is noted, and there is a fixed flexion deformity of 10° with further flexion up to 100°, i.e., there is an extension block terminally. X-rays and computed tomography scan showed medial condyle Hoffa's malunion with obvious intra-articular step. Treatment aims to reduce the articular surface anatomically and provide rigid and stable fixation. Treatment's objectives included easing pain and addressing deformities and improving the range of movements and early mobilization. The patient was assessed clinically with a Knee Society Score. The primary method of treatment for Hoffa's malunion is surgical. Intra-articular osteotomy should be taken into consideration as a salvage option in the younger population to prevent arthritis. The use of an antiglide plate in conjunction with screws provides rigid and stable fixation.