Hoffa fracture

Description

Unicondylar coronal fracture of the lateral femoral condyle. Rare intra-articular distal femur injury. Axial compression to the knee with transmission of the ground reaction force through the tibial plateau to the femoral condyles.

History of the Hoffa fracture

1869 – Friedrich Busch (1844 – 1916) described a knee joint found within the anatomical collections of the Department of Surgery in Berlin. The specimen came from the corpse of a muscular man, who died of the consequences of a severe injury sustained several years before his death. After maceration of the distal femur, a fissure separating the posterior lateral femoral condyle became visible. [Case VIII, Fig 6]

1888 – Hoffa allegedly used Busch’s drawing in a chapter on Fracturen des unteren Femurendes in the first edition of his textbook without citing the original source. The fracture was mentioned briefly by Hoffa in a single sentence.

1889 – Ludwig Wilhelm Carl Rehn (1849-1930) presented to the German Surgical Society the case of a 45-year-old man who suffered a knee injury some 16 years before his demise (from ‘phlegmon’). Autopsy revealed an avulsion of the lateral femoral condyle in the coronal plane. An osteoarthritic fragment was displaced posteriorly and proximally. The cruciate ligaments were intact, but the lateral meniscus and posterior lateral condyle of the tibia was severely damaged. Christian Heinrich Braun (1847–1911) was present at Rehn’s presentation and intimated he had a similar case to present.

1891 – Braun published the case of a details of a 48-year-old man sustained an open injury to the left knee. Ten days post injury the knee joint became infected and the limb had to be amputated. Autopsy revealed a minimally displaced two fragment fracture of the lateral femoral condyle. The posterior capsule and the cruciate ligament remained intact. [Qaerbruch des hinteren Theiles des Condylus. 1891; 42 :107–111]

1904 – Hoffa added slightly more detail of the fracture in the 4th edition of his book in 1904: 451. This is wrongly most commonly quoted as the original description

1978 – The term Hoffa fracture began to appear at the turn of the 1970s, primarily in the German and French literature, together with descriptions of its modifications. Letteneur presented one of the first prognostic classifications in 1978, defining 20 cases and using the descriptive term the ‘Hoffa fracture’

2018 – Pires et al propose a treatment algorithm, guiding treatment, approach and fixation based on a modified Letenneur classification of coronal plane distal femur fractures.

Associated Persons

• Albert Hoffa (1859 – 1907)
• Friedrich Carl Ferdinand Busch (1844 – 1916)
• Ludwig Wilhelm Carl Rehn (1849-1930)
• Christian Heinrich Braun (1847–1911)

Alternative names

• Busch fracture
• Busch-Hoffa fracture

Controversies

Hoffa fracture: Although Hoffa did describe this fracture, he was neither the first to do so, nor did he publish this description in 1904. Probably a better description would be the Busch-Hoffa fracture or Busch-Rehn-Braun fracture

References

• Busch F. Fall VIII. Infraction des Condyl. ext femoris. In: Mehrere Fälle seltener Knochenverletzungen. Archiv für klinische chirurgie 1869; 10: 715-716
• Hoffa A. Fracturen des unteren Femurendes. In: Lehrbuch der Frakturen und Luxationen für Ärzte und Studierende. 1888; 1e: 452 and 1904; 4e: 451
• Rehn L. Präparat von Querbruch des Condylus externus femoris. Verhandlungen der Deutschen Gesellschaft für Chirurgie. 1889; XVIII Congres: 136-137
• Braun H. Qaerbruch des hinteren Theiles des Condylus. In: Seltenere Fracture des Oberschenkels. Archiv für klinische chirurgie 1891; 42 :107–109
• Letteneur J et al. Fractures de Hoffa – A propos de 20 observations. Annales de chirurgie 1978; 32: 213–219
• Bartoníček J, Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. Int Orthop. 2015; 39(6): 1245-50.
• Pires RE et al. Algorithmic Treatment of Busch-Hoffa Distal Femur Fractures:A Technical Note Based on a Modified Letenneur Classification. Injury. 2018 Aug;49(8):1623-1629
• Somford MP et al. Biographical background and origin of common eponymous terms in orthopedic surgery: anatomy and fractures in knee surgery. Eur J Orthop Surg Traumatol. 2018 Jan;28(1):79-84