Missed Hoffa Fracture in Skeletally Immature Patient Complicated by Non-union Pseudoarthrosis Case Report and Review of Literature

Hoffa fractures are uncommon clinical entity typically seen in adults after high-energy trauma, and commonly missed. Moreover, it’s extremely rare in children and young adolescents. According to our knowledge only 7 cases were reported in the literature with coronal fracture of the femoral condyle in children and young adolescents until the last search in 30 August 2019. Five of these seven cases discussed fresh fractures and other two cases discussed a missed Hoffa fractures complicated with non-union. In this study we present another case of missed coronal fracture of the lateral femoral condyle that subsequently went on to non-union and pseudoarthrosis in a 12 years old boy. The patient presented 4 months after motor vehicle accident with symptoms of right knee pain, snapping and instability. Radiological evaluation revealed a non-united lateral Hoffa fracture. The non-united fragment involved about two third of the lateral femoral condyle. operative intervention was our decision, diagnostic arthroscopy was done 1st then open arthrotomy using anterolateral approach for excision of pseudoarthrosis, open reduction and internal fixation of the fracture. Six months postoperative outcome was satisfactory, with full range of motion and return to sport.