Conjoint bicondylar Hoffa fracture in an adult
A 17-year-old male labourer presented to Orthopaedic emergency with the complaint of acute pain and swelling in his right knee following trauma. He had a fall from a 10-m-high ladder with direct impact on his semiflexed right knee. There were no associated injuries and the patient was hemodynamically stable.\nLocal examination revealed a painful swollen right knee with a 1 cm × 1 cm lacerated wound over the anterior aspect of the knee []. The range of movements were restricted. There was no distal neurovascular deficit or signs of raised compartment pressure. Plain radiographs revealed fracture distal end femur but were inadequate to define the exact fracture pattern []. Noncontrast computed tomographic (CT) scan was performed which established the diagnosis of conjoined bicondylar Hoffa fracture [].\nThe patient was operated in supine position under tourniquet and regional anesthesia. The lacerated wound was meticulously debrided. The knee joint was then exposed by swashbuckler (modified anterior) approach. A lateral parapatellar arthrotomy was done. The vastus lateralis was retracted laterally after lifting it up from the lateral femoral side. The rest of the extensor mechanism along with the patella was retracted medially for unobstructed visualization of both femoral condyles. On exposing the knee, a tangential fracture involving both the femoral condyles was noted []. Both the condyles were joined by a thin bridge of intact bone forming the roof of the intercondylar notch []. Both the cruciate ligaments and menisci were intact. In an attempt to reduce the fracture, the intervening bridge got breached. However, reduction was achieved and five 6.5 mm cannulated cancellous screws were passed from anterior to posterior direction through the nonarticular part under fluoroscopy control. The wound was closed in layers. Post operatively above knee back splint with 30° of knee flexion was applied for 2 weeks. After 2 weeks, intermittent knee mobilization started along with isometric muscle strengthening exercises. Partial weight bearing was started at 6 weeks postoperatively and full weight bearing at 3 months when the fracture had united radiologically. At 18 months, patient had 0°–145° of range of movements without pain and deformity []. He had 10° of extensor lag which was correctable. Radiographs showed no signs of avascular necrosis, osteoarthritis, or implant breakage []. The patient consented for using his data for publication.