Neglected Busch-Hoffa fracture following the patellar dislocation: a rare case report

Busch-Hoffa fractures are rare intra-articular coronal plane fractures of the femoral condyle that often remain unnoticed, particularly when complications develop. Due to their instability and risk of long-term problems, these fractures require immediate anatomical reduction and stable fixation. The occurrence of a Busch-Hoffa fracture in conjunction with patellar dislocation is extremely rare and has been rarely reported in the current literature.

We report a case involving a 21-year-old male who experienced a Bagaria type 2 Hoffa fracture of the lateral femoral condyle due to a twisting knee injury during exercise, which was associated with an acute lateral patellar dislocation. Imaging studies revealed a displaced osteochondral fragment from the posterior-inferior lateral femoral condyle, along with a fracture of the medial patellar facet. The patient underwent an open reduction using a lateral parapatellar approach. We achieved anatomical reduction of the condylar fragment, which was then secured with four Herbert screws. The torn medial patellofemoral ligament was repaired and reefed, and any loose bodies were excised. At an 18-month follow-up, the patient exhibited full knee range of motion, with no evidence of pain, instability, or degenerative changes.

The distinct fracture pattern, coupled with the patellar entrapment in the fracture line, presented diagnostic and surgical difficulties. This case highlights the need for heightened clinical suspicion, prompt computed tomography (CT) imaging, and careful surgical planning. The current literature is deficient in providing a definitive treatment protocol, and there is limited biomechanical data available on these types of injuries.

This unusual instance presents a complex case of Busch-Hoffa fracture, accompanied by patellar dislocation. Prompt open reduction and internal fixation are crucial for avoiding complications and restoring joint function.