Successful single stage management of trifocal femoral fracture associated with distal medial condyle and Hoffa’s component by a novel technique


  • Kumardev Arvind Rajamanya Department of Orthopedics, Manipal Hospitals Whitefield, Bangalore, Karnataka, India
  • Girish Marappa Department of Orthopedics, Manipal Hospitals Whitefield, Bangalore, Karnataka, India



Trifocal fracture, Locking compression plate, Intra-medullary interlocking nail, Hoffa’s fracture


Isolated fractures of the shaft of the femur are relatively common injuries. Ipsilateral multifocal fractures of the femur are less common with an additional proximal femoral fracture estimated to occur in up to 5% of diaphyseal fractures and additional distal femoral fracture occurring in 3-4%. Trifocal femoral fractures consisting of ipsilateral fractures of the proximal, diaphyseal, and distal femur are extremely rare. These fracture patterns are seen in the young adult population following high velocity trauma such as fall from height and road traffic accidents. The sequence of fracture type to be fixed first and the type of implant to be used are questions yet to be answered as one implant used for fixation of one fracture may not be amenable for fixation of the other fracture. These fractures are associated with significant complications and delayed rehabilitation. We describe a novel method in one such trifocal fracture pattern where the distal femoral intra-articular medial condyle with a hoffas element was stabilised by open reduction with a 4.5 proximal tibial ipsi-lateral anterolateral LCP and 2 inter-fragmentary compression screws which has not been reported in literature before. The advantages of such an implant is easy contour ability to the medial femoral condyle and adequate strength and achieving satisfactory absolute stability with options of using uni-cortical locking screws, all of which facilitates early knee ROM and rehabilitation.



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