Bicondylar Hoffa's fracture with patellar dislocation – a rare case

Abstract

Bicondylar Hoffa's fractures of the femur is very uncommon. Conjoint bicondylar Hoffa fracture with ipsilateral patellar dislocation, Bicondylar Hoffa's with patellar fracture and extensor mechanism rupture has been described in literature. We report a case of unconjoint bicondylar Hoffa's fracture with lateral patellar dislocation in 17-year-old male patient treated with open reduction and cancellous screw fixation that subsequently healed well with good functional outcome.

Pediatric conjoint Hoffa's fracture: An uncommon injury and review of literature

“…Bicondylar variety is rare, more so in pediatric age group. [1][2][3][4][5] Hoffa fractures are supposed to happen by a shearing force on the posterior femoral condyle; both direct impact and vertical shear with twisting mechanisms have been proposed. Lewis et al 9 argued that axial load to the lateral femoral condyle with the knee in 908 or more of flexion produces these posterior tangential fracture patterns and rotational force may modify orientation of fracture line.…”

A rare case of Hoffa fracture combined with lateral patellar dislocation

“…More rarely, this injury is seen in combination with patellar dislocation [3] . Beside dislocation of the patella, the Hoffa fracture is also described with knee dislocation [4] , femoral shaft fracture [5] , meniscal tear [6] , bicondylar fracture [3] , or incarceration of the patella into the fracture [7] . Therefore, we recommend a CT scan for analysis of the fracture pattern and an MRI, if there is any hint for combined injuries.…”

Conjoined bicondylar coronal plane fracture of the distal femur associated with incarcerated patella

“…Mounasamy et al ,9 used the transverse approach because of associated patellar fracture and traumatic transverse arthrotomy in his case. Anterior midline approach,4 12 and modified anterior7 11 (swashbuckler) approach are now the standard operating procedure for closed bicondylar coronal plane fracture. In our case, we utilised the anterior midline approach with medial parapatellar arthrotomy as patella was laterally dislocated and found to be irreducible even under anaesthesia.…”

“…But posteroanterior directed screws is difficult to insert in the clinical scenario. Most of the authors used anteroposterior lag screw 4 5 7 8 12. Controversy exists about the number and diameter of the screws used while most authors used 4–5 large-fragment PTCS 3 4 11.…”

“…Controversy exists about the number and diameter of the screws used while most authors used 4–5 large-fragment PTCS 3 4 11. Two to multiple screws,9 either cortical screws,8 or small-fragment cannulated screws,6 12 have also been used and described.…”