Complex Variant of Paediatric Conjoint Bicondylar Hoffa Fracture: A Rare Entity
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CASE REPORT
Complex Variant of Paediatric Conjoint Bicondylar Hoffa Fracture: A Rare Entity Sumedh D. Chaudhary1 · Sagar R. Raghuwanshi2 Received: 31 May 2020 / Accepted: 17 August 2020 / Published online: 28 August 2020 © Indian Orthopaedics Association 2020
Abstract Isolated, closed, conjoint bicondylar Hoffa fracture in a child is extremely rare with only three cases reported in literature till date. We report a complex variant of this very rare injury. An 11-year-old male child reported 2-week post-trauma with history of fall from a tree and injury to his right knee. Radiographs revealed a coronal plane fracture of the distal femur. The patient was operated using the swashbuckler approach, which revealed a sagittal split of the lateral femoral condyle along with a conjoint bicondylar Hoffa fracture. Fixation was done using multiple lag screws and fracture went on to uneventful union. Patient was followed up for 3 years and except for limb shortening of around 1.5 cm secondary to premature physeal closure as a consequence of the injury, he had excellent outcome with full range of motion at the knee, without any deformity. Keywords Bicondylar Hoffa fracture · Swashbuckler approach · Conjoint · Coronal fracture · Variant Abbreviations CT Computed tomography mm Millimetre
bicondylar Hoffa fracture have been reported in English literature till date [2–4]. We are reporting a complex variant of a closed, conjoint bicondylar Hoffa fracture in a child.
Introduction
Case Presentation
A Hoffa fracture is a coronal plane fracture of the distal femur. It is usually seen in combination with epiphyseo-metaphyseal fractures of the distal femur [1]. As these injuries are a result of high energy trauma, they are usually seen in polytrauma patients and open injuries are common. Isolated Hoffa fractures are rare in adults and much rarer in children and usually involve only one condyle, mostly the lateral condyle. Hoffa fracture involving both the condyles is extremely rare [2]. When the fracture line passes such that both the Hoffa fragments are joined by a bridge of bone, it is called as a conjoint bicondylar Hoffa. To the best of our knowledge only three cases of closed, isolated, paediatric conjoint
An 11-year-old boy sustained injury to the right knee following fall from a tree. Initially, he was taken to an osteopath and presented to us 2 weeks later with a swollen right knee and inability to bear weight on the affected lower limb. On examination, his knee was tender and any attempted movements at the knee were severely painful and restricted. There were no signs of any external wound. Distal pulsations were well felt and there was no distal neurovascular deficit. Antero-posterior and lateral radiographs revealed a coronal plane fracture of the distal femur (Fig. 1). Although a Computed Tomography (CT) scan was desirable to evaluate the fracture morphology, it could not be done for technical reasons. The patient was posted for open reduction and internal fixation. With patient in supine position on a radiolucent top
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