Discussion
In certain cases, a high energy trauma can result in a bicondylar Hoffa
fracture, a condition that is very rare (7). Various factors contribute
to the complexity of the anatomy of Hoffa fractures, including
diagnostic difficulties, surgical exposure challenges, the inability to
use conventional implants, as well as the weak and variable fixation
constructsIn this system, based on CT scan images that were used in the
formation of this system, fracture patterns were classified as a result
of their fault distribution according to the fracture pattern itself.
Generally, a type 1 fracture occurs at a point near the junction between
the posterior condyle and the shaft of the femur, approximately
coronally to the site of fracture, when the fracture line is located
near this junction. Approximately 2.5 cm of the fragment extend from the
posterior-most point of the posterior condyle to the most anterior point
of the fragment. It is known as Type 2 fracture if the fracture line
passes anteriorly to the junction between the posterior femoral condyle
and shaft, resulting in a 2.5 cm fragment. Usually, comminuted coronal
fractures of the femur are seen in type 3. A type 4 fracture may be
classified as one of four types: an anterior lip fracture type 4a; a
bicondylar fracture type 4b; a marginal osteochondral fracture type 4c;
and a supracondylar fracture of the distal femur fracture type 4d (12).
Radiographs of anteroposterior and lateral Hoffa fractures can often be
difficult to detect when they are not displaced. A CT scan may be
necessary if fracture morphology is uncertain, according to an oblique
radiograph (3). In order to assess the right knee, we obtain plain
radiography (in frontal and lateral views) as well as a 3D-CT scan
(Figures 1 and 2). Figure 1 shows a hoffa fracture that cannot be seen
clearly, but figure 2 shows it very clearly and as can be seen, it is
bycondylar. Additionally, ”Type 4” fractures are intrinsically unstable
and require surgical fixation as a result of continuous shear stresses
both coronal and sagittal. This type of fracture requires individual
management depending on the severity of the injury. There was a Hoffa
fracture in our case that was affecting the bicondylar region (4b).
Depending on the fracture geometry, fragment size, and comminution,
these fractures can be treated as two different entities. In cases where
the fragment is larger than 2.5 cm, an anterior to posterior screw can
suffice, while a posterior to anterior screw is essential in cases where
the fragment is smaller. The Swashbuckler approach is also a viable
option (12). Therefore, we use a 5 cm incision on both sides of the
distal femur to perform a double incision. For this surgery, we used
screws and wires in the deep flexion position, directed anteriorly
perpendicular to the fracture plane in order to compress the fracture.
After that, the fractures in the medial wall of the medial condyle were
repaired with reconstruction plates as anti-glide plates. In the absence
of surgery, nonoperative treatments such as plaster casts or skeletal
traction lead to a loss of extension, nonunion, instability, and
deformity of the joints (13). Infectious hazards, vascular degeneration,
and fragment necrosis have been reported with this surgical approach
(11), but we avoided these concerns with antibiotic therapy and
intensive care.