Hoffa Fracture in Skeletally Immature Patients: A Case Report and Review of Literature.

INTRODUCTION: Hoffa fractures are the fractures of the femoral condyles in the coronal planes. These are uncommon in adults and notably rarer in pediatric population. In this fracture, either one or both the femoral condyles may get involved following the injury. Such rare clinical entity warrants a high index of suspicion with apt radiological corroboration for meticulously diagnosing and planning out the treatment.

CASE REPORT: We report a rare case of Hoffa fracture involving the medial femoral condyle of right knee and undisplaced right patella fracture in a 6-year-old girl. The radiological investigations (radiographs and computed tomography [CT] scan) were done and her leg was immobilized by above knee posterior slab. Our treatment plan included surgical intervention to do open reduction and internal fixation using k-wires and two 4.5 mm partially threaded cannulated cancellous screws and was done with due care to prevent any damage to epiphysis. No signs of osteonecrosis, heterotopic ossification or physeal growth arrest in radiograph taken at 10th month were noted. The child is still under follow-up.

CONCLUSION: Hoffa fracture is a rare variety and the diagnosis of the same warrant a higher index of suspicion with more watchful eye. CT-scan firmly establishes the missed diagnosis and notably provides with the detailed configuration of the fracture to guide the treatment plan. Surgical intervention (open reduction and fixation or arthroscopy based procedures) is essential over the non-operative treatment to alleviate complications.