Single-Stage Fixation of Bilateral Open Medial Hoffa Fractures Associated with Bilateral Patella Fracture and Bilateral Distal Radius Fractures: A Case Report.

Introduction: Hoffa fractures are uncommon coronal-plane fractures of the femoral condyle. Bilateral open medial Hoffa fractures associated with patellar fractures, knee dislocation, vascular compromise, and bilateral distal radius fractures are exceptionally rare and present major diagnostic, surgical, and rehabilitation challenges. Case Report: A 23-year-old man sustained polytrauma in a two-wheeler road traffic accident. He had bilateral open medial femoral condyle fractures, bilateral patellar fractures, a posterior dislocation of the right knee with compression of the popliteal artery, and bilateral distal radius fractures. Emergency closed reduction of the right knee restored distal perfusion. After resuscitation from hypovolemic shock and achievement of haemodynamic stability, single-stage definitive fixation was performed. The Hoffa and patellar fractures were stabilised with fracture-specific fixation and extensor-mechanism reconstruction. The right distal radius was fixed with a volar plate, whereas the open left distal radius fracture was managed with Kirschner wires and a wrist-spanning external fixator. Results: At 1-year follow-up, all fractures had united without infection or neurovascular deficits. Both knees had a range of motion from 0° to 120°, with Lysholm scores of 91 on the right and 90 on the left. Both wrists had near-full motion and Modified Mayo Wrist Scores of 85. The patient was independently ambulant and had returned to his pre-injury occupation. Conclusion: In selected polytrauma patients who respond adequately to resuscitation, single-stage definitive fixation can be considered after urgent vascular compromise has been addressed. Individualized fixation, meticulous soft-tissue management, and coordinated rehabilitation are essential for a favorable outcome.