VOL. 95-B, No. 9, SEPTEMBER 2013 1165  INSTRUCTIONAL REVIEW: TRAUMA Coronal plane partial articular fractures of the distal femoral condyle CURRENT CONCEPTS IN MANAGEMENT M. H. Arastu, M. C. Kokke, P. J. Duffy, R. E. C. Korley, R. E. Buckley From Foothills Medical Centre, Calgary, Alberta, Canada  M. H. Arastu, BSc, MSc, FRCS(Tr & Orth), Orthopaedic Surgeon Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK.  M. C. Kokke, MD, Trauma Surgeon  P. J. Duffy, MD, FRCSC, Orthopaedic Surgeon  R. E. C. Korley, BSc, MDCM, FRCSC, Orthopaedic Surgeon  R. E. Buckley, MD, FRCSC, Professor of Orthopaedic Surgery Foothills Medical Centre, Division of Orthopaedic Surgery, 0490 Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada. Correspondence should be sent to Mr H. Arastu; e-mail: marastu@hotmail.com ©2013 The British Editorial Society of Bone & Joint Surgery doi:10.1302/0301-620X.95B9. 30656 $2.00 Bone Joint J 2013;95-B:1165–71. Coronal plane fractures of the posterior femoral condyle, also known as Hoffa fractures, are rare. Lateral fractures are three times more common than medial fractures, although the reason for this is not clear. The exact mechanism of injury is likely to be a vertical shear force on the posterior femoral condyle with varying degrees of knee flexion. These fractures are commonly associated with high-energy trauma and are a diagnostic and surgical challenge. Hoffa fractures are often associated with inter- or supracondylar distal femoral fractures and CT scans are useful in delineating the coronal shear component, which can easily be missed. There are few recommendations in the literature regarding the surgical approach and methods of fixation that may be used for this injury. Non-operative treatment has been associated with poor outcomes. The goals of treatment are anatomical reduction of the articular surface with rigid, stable fixation to allow early mobilisation in order to restore function. A surgical approach that allows access to the posterior aspect of the femoral condyle is described and the use of postero-anterior lag screws with or without an additional buttress plate for fixation of these difficult fractures. Cite this article: Bone Joint J 2013;95-B:1165–71. Isolated coronal plane fractures of the femoral condyle are rare, representing 0.65% of all fem- oral fractures. 1 The fracture was described by Hoffa 2 in 1904, although similar fractures had been reported as early as 1869. 3 The lateral femoral condyle has been reported to be more commonly injured 1,4-7 than the medial con- dyle, 5,8-15 and bicondylar fractures have also been described. 16-20 The relative incidence of lateral condyle fractures is as high as 78% to 85%. 5,11 However, the injury is often over- looked, especially if undisplaced or associated with a distal femoral inter- or supracondylar fracture (38.1%). 5 In order to avoid missing this fracture and to plan surgical treatment, the use of computerised tomography (CT) has been rec- ommended in all patients who have sustained a high-energy intra-articular distal femoral frac- ture or have a lipohaemarthrosis with an occult fracture. 5,21 The Hoffa fracture is an intra-artic- ular fracture in a major weight-bearing joint, at risk of displacement if unrecognised. 6,7,22,23 Non-operative treatment has been associated with poor functional outcomes. 4,23,24 Operative treatment with anatomical reduction and rigid internal fixation is recommended with early rehabilitation. There is a paucity of data (pre- dominantly Level 4/5 evidence) recommending which surgical approach and what implants are the most appropriate. The aim of this article is to review the litera- ture and make recommendations for treatment and future research. Anatomy and mechanism of injury Hoffa 2 fractures are associated with high- energy trauma. Nork et al, 5 describing 77 supracondylar-intercondylar fractures with an associated coronal plane fracture, reported that 80.5% occurred as a result of motor vehicle/ motorcycle accidents and 9.1% as a result from a fall from a height. The mechanism of injury has been reported to be a direct antero-posterior force to a flexed and abducted knee for a lateral condylar fracture, 1 and direct impact to the medial side of the knee in flexion for a medial condylar fracture. 11 The lateral condyle is more commonly fractured, probably as a result of the physiological valgus of the knee, with a direct force exerted against the tibial plateau, 17,23 and different fracture patterns have been described where simultaneous vertical shear and twisting forces occur. 19 The exact reason for the prepon- derance of lateral condyle fractures remains unclear, as the mechanical axis of the knee becomes more varus when the knee is flexed. 25 Classification In 1978 Letenneur et al 4 divided Hoffa frac- tures into three types based on the distance of