Posterior Approach for Single-stage Fixation of Medial Hoffa with Posterior Cruciate Ligament Avulsion: A Rare Case Report.

Introduction: Medial Hoffa fractures are rare intra-articular injuries of the femoral condyle, and their association with posterior cruciate ligament (PCL) avulsion fractures presents a highly uncommon and complex clinical scenario. This case report describes the successful surgical management of such a combination using a posterior open approach. Case Report: A 48-year-old male sustained a medial Hoffa fracture with a PCL avulsion following a road traffic accident. Surgical intervention involved open reduction and internal fixation (ORIF) through a posterior approach, allowing direct access to both fracture sites. The PCL avulsion fragment was anatomically reduced and fixed with a cancellous screw, while the Hoffa fracture was stabilized using opposing Herbert screws. Postoperatively, the patient underwent structured rehabilitation with an early range of motion exercise. At 6 months, the patient achieved full knee function (0-130°), no instability, and high functional scores. Radiographs showed complete union, and follow-up at 18 months confirmed maintained function without complications. Conclusion: This case highlights the effectiveness of a posterior approach for single-stage ORIF in managing rare medial Hoffa fractures with PCL avulsion. Early surgical intervention, anatomical fixation, and dedicated rehabilitation are key to achieving optimal outcomes in such complex knee injuries.