Fixation of an ipsilateral bicondylar Hoffa's fracture via medial para patellar approach using multiple screws - A case report

Background: An ipsilateral bicondylar Hoffa's fracture having the simultaneous involvement of both the medial and the lateral femoral condyle on the same side is very rare. Choosing a surgical approach with limited access to fix Hoffa's fracture may lead to a non-anatomical reduction, ultimately ending up with sub-optimal results like malunion, non-union, knee stiffness, and early osteoarthritis. Case report: We herein discuss the successful management of an ipsilateral bicondylar Hoffa's fracture having a metaphyseal spike in a 37-year-old male with AP screws via the Medial Para Patellar approach (MPPA). We limited the fixation to only two 6.5 mm screws with washers through each condyle to minimize the damage to the intra-osseous blood supply. An apical screw was used instead of adding a plate posteriorly to minimize the iatrogenic damage to the extra-osseous blood supply of the condyles. The whole procedure was done without a tourniquet. The entry point of all the screws was from an extra-articular area anteriorly so there was no need to countersink the screw heads. The benefit of MPPA is that if arthroplasty of the knee is ever required, it can be performed through the original incision without damaging the skin's vascularity. Conclusion: Computed Tomography (CT) scan is indispensable for the exact fracture characterization of Hoffa's fracture, planning of surgical approach, and screw trajectory. In our experience, the medial parapatellar approach is dependable to deal with such fractures and provides adequate exposure for fracture fixation even if it is accompanied by a metaphyseal spike