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. 2025 Nov 3:17:145865.
doi: 10.52965/001c.145865. eCollection 2025.

Pediatric lateral Busch-Hoffa fracture associated with lateral meniscus tear and incarcerated popliteus tendon: systematic review of literature and case report

Tine De Mulder  1 , Adanna Welch-Phillips  1 , Mohamad Mosri  1 , Jim Kennedy  1   2 , Patrick O'Toole  1   3
Affiliations

Pediatric lateral Busch-Hoffa fracture associated with lateral meniscus tear and incarcerated popliteus tendon: systematic review of literature and case report

Tine De Mulder et al. Orthop Rev (Pavia). .

Abstract

Introduction: Busch-Hoffa fractures are rare, particularly in the pediatric population, with limited available literature. As it is an inherently unstable fracture and as the posterior femoral condyle is prone to non-union, correct and adequate treatment of the fracture is critical but challenging.

Objective: This study aims to (1) systematically review the literature on pediatric Busch-Hoffa fractures, and (2) present a rare case of a lateral Busch-Hoffa fracture with a bucket-handle lateral meniscus tear and popliteus tendon incarceration in a pediatric patient.

Methods: A systematic review was performed in February 2025 using PubMed/MEDLINE, identifying English-language articles on Busch-Hoffa fractures in patients aged ≤16 years. PRISMA guidelines and quality assessment tools were applied.

Results: A literature search identified 20 cases, predominantly occurring in males (66.7%) with an average age of 11.35 years. Falls and motor vehicle accidents were the most common mechanisms of injury. Open reduction and internal fixation was performed in 85% of cases, with generally favorable outcomes. Three cases presented with a concomitant osseous injury and two were associated with a soft tissue injury.

Conclusion: Although rare, pediatric Busch-Hoffa fractures must not be overlooked. Existing literature is sparse and consists primarily of case reports. Given the high risk of instability and non-union, surgical fixation remains the preferred treatment. Our case contributes to existing literature by presenting a unique combination of Busch-Hoffa fracture with significant soft tissue involvement, underscoring the role of arthroscopy in assessing and managing concomitant injuries.

Keywords: Busch-Hoffa fracture; Hoffa fracture; meniscus tear; pediatric knee injury; pediatric trauma; popliteus tendon; systematic review.

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Conflict of interest statement

None

Figures

Afbeelding met tekst, schermopname, ontvangst, diagram Door AI gegenereerde inhoud is mogelijk onjuist.
Figure 1.. Flowchart of search strategy using the PRISMA 2020 guidelines
*Filter: Full text articles, English language From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71
Figure 2.
Figure 2.. 1) Radiographs at presentation of left knee (a) anteroposterior view (b) lateral view. 2) MRI of left knee showing Busch-Hoffa fracture of the lateral condyle, lateral meniscus tear and effusion (a) axial view (b) sagittal view (c) coronal view. 3) CT of left knee (a) sagittal view (b) axial view.
Afbeelding met Medische apparatuur, medisch, gezondheidszorg, overdekt Door AI gegenereerde inhoud is mogelijk onjuist.
Figure 3.. Intra-operative images of a) irreducible lateral meniscus tear with the Busch-Hoffa fracture visible in the background and b) the Busch-Hoffa fracture of the lateral condyle with stay sutures used to retract capsule.
Afbeelding met kunst Door AI gegenereerde inhoud is mogelijk onjuist.
Figure 4.. Illustration of incarcerated popliteal tendon in lateral Busch-Hoffa fracture.
Afbeelding met röntgenfilm, joint, Medische beeldbewerking, radiologie Door AI gegenereerde inhoud is mogelijk onjuist.
Figure 5.. 1) Clinical photographs showing range of motion eight months after surgery (a) knee extension (b) knee flexion. 2) Radiograph seven months after surgery showing fracture union and anatomical reduction (a) anteroposterior view (b) lateral view.
See this image and copyright information in PMC

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