Busch-Hoffa fracture: A systematic review

BACKGROUND: Accomplish a thorough review on the existing biomechanical and clinical studies about coronal plane fractures of the distal femur. METHODS: We performed an electronic search of PubMed/MEDLINE database from April to June, 2023. The terms for the database search included “Hoffa fractures,” OR “Busch-Hoffa fractures” OR “coronal plane fractures of the distal femur.” RESULTS: The search identified 277 potentially eligible studies. After application of inclusion and exclusion criteria, 113 articles were analyzed in terms of the most important topics related to coronal plane fractures of the distal femur. CONCLUSION: Lateral coronal plane fractures of the distal femur are more frequent than medial, present a more vertical fracture line, and usually concentrate on the weight bearing zone of the condyle. The Letenneur system is the most used classification method for this fracture pattern. Posterior-to-anterior fixation using isolated lag screws (for osteochondral fragments—Letenneur type 2) or associated with a posterior buttressing plate (when the fracture pattern is amenable for plate fixation—Letenneur types 1 and 3) is biomechanically more efficient than anterior-to-posterior fixation. Anterior-to-posterior fixation using lag screws complemented or not by a plate remains a widely used treatment option due to the surgeons’ familiarity with the anterior approaches and lower risk of iatrogenic neurovascular injuries. There is no consensus in the literature regarding diameter and number of screws for fixation of coronal plane fractures of the distal femur.