Medial Hoffa Fracture in a Young Adult: Rare Injury, Successful Fixation in a Remote Low‑Resource orthopaedic Hospital in Northern Pakistan

Introduction: Medial Hoffa fractures are rare coronal-plane distal femoral fractures often resulting from high-energy trauma such as road traffic accidents or falls from height; accurate diagnosis and stable fixation are essential to restore knee function and prevent long-term complications [1, 2]. Case Presentation: We report a case of a 25-year-old male who sustained a two-part comminuted medial Hoffa fracture (CT type B) following a road traffic accident. Emergency management included analgesia, the RICE protocol, and immobilization with an above-knee back slab. Preoperative optimization included CBC, LFTs, RFTs, hepatitis B and C, HIV serology, and blood grouping. The patient underwent open reduction and internal fixation (ORIF) with six 3 mm Herbert headless screws (four posteroanterior, two anteroposterior). No postoperative complications occurred. Follow-up over three months showed progressive improvement in Knee Injury and Osteoarthritis Outcome Score (KOOS) from 42 at 2 weeks to 92 at 3 months [3]. Conclusion: This case demonstrates that meticulous perioperative planning and surgical technique can achieve excellent outcomes in rare intra-articular fractures even in remote, low-resource hospitals [4, 5].