Surgical Discussion

Patient positioning:  The patient was positioned supine with the knee in hyperflexion to facilitate access to the small type two Hoffa component.

Anatomical surgical approach:  The surgical approach consisted of an anterolateral incision to expose the lateral condyle and trochlear fragment, followed by a medial subvastus approach to access the medial Hoffa fractures. The type one Hoffa component was buttressed, while screws were placed posterior to anterior for stabilization of the type two component.

The surgeon noted the complexity of modulating construct stiffness in this geriatric distal femur fracture. The decision was made against using a distal femoral replacement due to the presence of an operative acetabulum above and anticipated three-month TTWB status. Instead, the focus was on achieving stable fixation through anatomic reduction and appropriate hardware selection.

Postoperative protocol:   The postoperative rehabilitation protocol included toe-touch weight bearing (TTWB) for three months due to the operative acetabulum above.

Follow up:   Not specified.

Orthopaedic implants used:   Orthopaedic implants used included interfragmentary screws and buttress plates.