Pediatric lateral Busch-Hoffa fracture associated with lateral meniscus tear and incarcerated popliteus tendon: systematic review of literature and case report.

Introduction: Busch-Hoffa fractures are rare, particularly in the pediatric population, with limited available literature. As it is an inherently unstable fracture and as the posterior femoral condyle is prone to non-union, correct and adequate treatment of the fracture is critical but challenging. Objective: This study aims to (1) systematically review the literature on pediatric Busch-Hoffa fractures, and (2) present a rare case of a lateral Busch-Hoffa fracture with a bucket-handle lateral meniscus tear and popliteus tendon incarceration in a pediatric patient. Methods: A systematic review was performed in February 2025 using PubMed/MEDLINE, identifying English-language articles on Busch-Hoffa fractures in patients aged ≤16 years. PRISMA guidelines and quality assessment tools were applied. Results: A literature search identified 20 cases, predominantly occurring in males (66.7%) with an average age of 11.35 years. Falls and motor vehicle accidents were the most common mechanisms of injury. Open reduction and internal fixation was performed in 85% of cases, with generally favorable outcomes. Three cases presented with a concomitant osseous injury and two were associated with a soft tissue injury. Conclusion: Although rare, pediatric Busch-Hoffa fractures must not be overlooked. Existing literature is sparse and consists primarily of case reports. Given the high risk of instability and non-union, surgical fixation remains the preferred treatment. Our case contributes to existing literature by presenting a unique combination of Busch-Hoffa fracture with significant soft tissue involvement, underscoring the role of arthroscopy in assessing and managing concomitant injuries.