Introduction
The isolated coronal plane fracture of the distal femoral condyle is a rare fracture described by Friedrich Busch (1844–1916) (1)in 1869 and named after Albert Hoffa (1859–1907) in 1904 (2). Only 0.65% of all femoral fractures occur in this way. It is often easy to diagnose, but on anteroposterior and lateral radiographs, Hoffa’s fracture may be overlooked due to overlapping condyles (3). In spite of the preponderance of lateral condyle involvement, medial condyle involvement is not as common as previously thought (4). An axial transmission of ground reaction force directed posteriorly in a flexed knee joint is the typical mechanism of injury that results in lateral condylar split fractures. A bicondylar Hoffa is a very rare condition which may occur if these forces are transmitted to both condyles due to direct impact over the knee. As this fracture occurs within the articulation, conservative management is often accompanied by a risk of malunion, nonunion, instability, and post-traumatic arthritis, which may compromise knee function (5-7). Therefore, current recommendations emphasize anatomical reduction and rigid internal fixation with lag screws or plates, according to fracture geometry and surgeon expertise (7-9). Those who suffer from “Type 4” fractures require individualized treatment based on their specific characteristics. It is denoted by ”4b” because bicondylar involvement is involved. The fracture geometry, fragment size, and combination of these fractures can lead to two different treatment strategies. An anterior to posterior screw can suffice if the fragment is larger than 2.5 cm, while a posterior to anterior screw is required if the fragment is smaller. It has also been suggested that double incisions or the Swashbuckler approach be used (10). Anatomical reduction and internal fixation are now the accepted methods of treatment for these fractures, as opposed to nonoperative treatment in the past (11). In this case report, we describe a bicondylar Hoffa fracture with avulsion of both the LCL and MCL.