Hoffa Fragments in the Geriatric Distal Femur Fracture: Myth or Reality?

Abstract

Background: Previous research reported the frequency of coronal plane (Hoffa) fractures in high-energy supracondylar femur fractures in a relatively young population. It is the purpose of this study to identify the frequency of coronal plane fractures seen in elderly patients. Methods: All patients over the age of 18 years treated for supracondylar femur fractures at 2 level I trauma centers were reviewed over a 4-year period. The patients were stratified (≥60 years and <60 years) and compared to determine differences in injury characteristics and fracture patterns with special attention to the prevalence of coronal plane fractures. Results: One hundred ten patients were identified with supracondylar femur fractures (12 Orthopaedic Trauma Association [OTA] 33A; 2 OTA 33B; 96 OTA 33C). Thirty-two of the 96 intercondylar fractures were in patients >60 years of age. The elderly group included a higher percentage of females (81% vs 36%, P = .0001) and was more likely to sustain their injury due to a fall (59% vs 19%, P = .0001). Coronal plane fractures were visualized on computed tomography scans in 56 (58%) of the 96 33C femur fractures. Forty-four percent of elderly patients sustained a coronal plane fracture compared with 66% of the younger cohort ( P = .04). The percentage of open fractures (30% elderly vs 46%) was not significantly different between the 2 groups ( P = .17). Conclusions: The occurrence rate of 44% in this study was higher than expected and is the first to provide this information in the elderly patients on this fracture. It is important that a high index of suspicion be maintained for the Hoffa fracture in all distal femur fractures, regardless of age or mechanism of injury.