Large osteochondral fractures of the lateral femoral condyle in the adolescent: outcome of bioabsorbable pin fixation.
ABSTRACT Large osteochondral fractures of the lateral femoral condyle of the knee in adolescent patients can be diagnostically and therapeutically challenging. Historically, management has involved removal of the fragment, leaving a large area of bone devoid of articular cartilage on the weight-bearing surface of the lateral femoral condyle. This study assessed open reduction and internal fixation of the osteochondral fragments with use of multiple polyglycolic acid rods.
Eight patients, between twelve and fifteen years old, with a large (>4 cm(2)) osteochondral fracture of the lateral femoral condyle were treated with open reduction and internal fixation with use of multiple polyglycolic acid rods. Each patient was evaluated at more than five years (a mean of nine years) after the index procedure with a clinical assessment, during which the knee was scored according to the International Knee Documentation Committee and Cincinnati knee rating systems, plain radiographs were made, and magnetic resonance imaging scans were acquired.
The majority of patients scored well on both knee rating systems, with no poor results. Five of the eight patients had normal findings on knee radiographs, and three had radiographs that showed minor changes. Magnetic resonance imaging scans of all patients demonstrated intact articular cartilage in the lateral compartment with no area of full-thickness articular cartilage loss. No evidence of articular cartilage thinning was seen in two knees; a small area of <2 cm(2) of cartilage thinning, in four; a moderate area of 2.7 cm(2) of cartilage thinning, in one; and a large area of 11.2 cm(2) of abnormal cartilage signal, in one knee.
Osteochondral fracture of the lateral femoral condyle is an injury to which adolescents with ligamentous laxity of the knee are prone. Our results show that internal fixation of these osteochondral fragments with bioabsorbable implants is possible and is a worthwhile option.
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ABSTRACT: Femoral or patellar osteochondral fractures complicating patellar dislocation are more frequently observed in adolescents than in adults. These incidental lesions of vulnerable joint cartilage are often neglected in the initial phase, which is regrettable given their good capacity for healing after repositioning. The objective of this study was to investigate the characteristics and analyze the results of repositioning these fractures in skeletally immature patients. This retrospective multicenter study grouped 14 patients and knees (seven females). The mean age at the time of the accident was 12.9 years (range, 11.2-14.9 years) for the girls and 14 years (range, 12.2-15 years) for the boys. These fractures involved the lateral condyle in nine cases and the patella in five cases. The injury mechanism was secondary to demonstrated patellar dislocation (n=9) or a direct impact (n=4). In nine cases out of 14, a leisure sports accident was the cause. The injury was treated a mean 5.2 days (range, 0-20 days) after the accident. All of the detached fragments were repositioned surgically with screw fixation (n=5), resorbable pins (n=5), or pull-out suture (n=4). Biological glue was added for six patients. Patellar stabilization was associated during the same procedure in two cases. No postoperative complications were observed. The results at the mean follow-up of 30 months (range, 15-89 months) showed no revision for failure, with all of the fractures demonstrating union at the final examination. The mean IKDC 2000 subjective score was 88±6 (range, 79-98) out of 100 points. The subjective satisfaction level was very satisfied in two cases and satisfied in the 12 others. The final IKDC score was A for eight patients, B for five patients, and C for one patient. Three patients underwent secondary patellar stabilization surgery. Better knowledge of this fracture and attentive reading of the radiographic images of a knee with hemarthrosis should result in more frequent diagnosis of this condition and adapted treatment. Unexplained hemarthrosis in a context of trochlear dysplasia should be considered to be associated with an OCF until proof of the contrary. A fragment released in a weightbearing zone should ideally be repositioned within 10 days but remains possible at 2 months. It regularly provides bone union and good results in children.Orthopaedics & Traumatology Surgery & Research 12/2011; 97(8 Suppl):S154-9. · 1.06 Impact Factor
Article: Arthroscopic surgery in children.[show abstract] [hide abstract]
ABSTRACT: Arthroscopic surgery for children and adolescents is developing fast, thanks to technical progress in adult arthroscopy, improved knowledge of child joint disorders, and instrument miniaturization. The specificity of arthroscopy in children lies, on the one hand, in the small joint size and, on the other, in the presence of neighboring growth plates. There also exist specific pathologies as well as differences in indications in pathologies common to children and adults. These specificities need to be known, and adapted techniques and equipment require to be used, given which arthroscopy is feasible even in infants. Growth plate must be respected, and the residual growth of the operated segment (e.g., in knee ligament reconstruction) needs to be known. Joint decoaptation often does not require traction, and any stress maneuvers (valgus/varus) need to be gentle. The knee is by far the most frequently implicated joint in child arthroscopy, partly due to a rise in sports injuries. There is a variety of traumatic pathologies (osteochondral or meniscal/ligament tears, etc.) and of indications. Arthroscopy in children is safe, given awareness of these indications and respect of certain precautions. The advantages over conventional open surgery are the same as in adults: simpler postoperative course, faster functional recovery and better esthetic result. Arthroscopy will continue to develop in pediatrics in coming years.Orthopaedics & Traumatology Surgery & Research 06/2010; 96(4):447-55. · 1.06 Impact Factor
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ABSTRACT: A retrospective study was performed on the use of bioabsorbable pins in the fixation of osteochondral fractures (OCFs) after traumatic patellar dislocation in children. Eighteen children (13 females, 5 males) aged 11 to 15 years (mean age 13.1 years) with osteochondral fracture (OCF) of the knee joint were treated at the authors' institution. Followup ranged from 22 months to 5 years. Diagnosis was verified by X-ray and magnetic resonance imaging (MRI) of the knee and patella. In seven patients the osteochondral fragment was detached from the patella and in 11 it was detached from the lateral femoral condyle. All patients were subjected to open reduction and fixation of the lesion with bioabsorbable pins. Postoperatively, the knee was immobilized in a cast and all patients were mobilized applying a standardized protocol. Bone consolidation was successful in 17 of the 18 patients. Bioabsorbable pins reliably fix OCF in children and adolescents, demonstrating a high incidence of consolidation of the detached osteochondral fragment in short- and middle-term followup without requiring further operative procedures.Advances in orthopedics. 01/2012; 2012:249687.