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.