Background: Isolated coronal plane fractures of the distal femoral
condyles (Hoffa fractures) occur uncommonly, are difficult to diagnose, and
may be challenging to treat. The combination of supracondylar distal femoral
fractures and these coronal plane fractures is thought to occur rarely. The
purposes of the present study were to identify the frequency of the
association between supracondylar-intercondylar distal femoral fractures and
coronal fractures of the femoral condyle and to describe the radiographic
evaluation of these injuries.
Methods: One hundred and eighty-nine patients with 202
supracondylar-intercondylar distal femoral fractures were retrospectively
evaluated clinically and radiographically.
Results: Coronal plane fractures were diagnosed in association with
seventy-seven (38.1%) of the 202 supracondylar-intercondylar distal femoral
fractures. Fifty-nine (76.6%) of these coronal fractures involved a single
condyle, and eighteen involved both the medial and lateral femoral condyles.
Eighty-five percent of the coronal fractures involving a single condyle were
located laterally. Patients with an open distal femoral fracture were 2.8
times more likely to have a coronal plane fracture than patients with a closed
fracture were (95% confidence interval, 1.54 to 5.25). Coronal plane fractures
were diagnosed in 47% of the 102 knees that were evaluated with computerized
tomography, compared with 29% of the 100 knees that were not (p = 0.008). Ten
coronal plane fractures that had been unrecognized preoperatively were
identified only at the time of operative fixation of the distal femoral
fracture; none of these fractures occurred in patients who had been evaluated
with computerized tomographic scanning preoperatively.
Conclusions: Coronal plane fractures frequently occurred in
association with high-energy supracondylar-intercondylar distal femoral
fractures; in the present study, the prevalence of associated coronal plane
fractures was 38%. The lateral condyle was involved more frequently than the
medial condyle was. Coronal plane fractures of both condyles were observed
commonly, and the majority of coronal plane fractures were associated with
open wounds. Since the surgical tactic for the treatment of a
supracondylar-intercondylar distal femoral fracture may be altered by the
additional diagnosis of a coronal plane fracture component, preoperative
computerized tomographic scanning of the injured distal part of the femur,
particularly when there is an associated open wound, is strongly
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.