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.