Osteochondral fracture in weight-bearing portion of lateral femoral condyle associated with patellar dislocation (original) (raw)
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Revista Brasileira de Ortopedia (English Edition), 2018
Osteochondral fracture after acute patellar dislocation in teenagers is relatively common (up to 60% of cases of patellar dislocation), but poorly diagnosed. There are several treatments proposed for this type of injury, but none well defined in the literature. A male patient, 13 years old, with a diagnosis of osteochondral fracture of the lateral femoral condyle after acute dislocation of the right patella. He underwent surgical treatment of the chondral injury, which consisted of suturing of the chondral fragment to the cartilage defect and, in a second approach, reconstruction of the medial patellotibial ligament and medial patellofemoral ligament with autologous flexor graft. Currently, the patient has been followed up for 16 months postoperatively for the suture of the chondral fragment and for 8 months for the ligament reconstruction. He has been evaluated through functional scores and T2 weighted magnetic resonance imaging. Acute fixation through direct bone suturing of a purely chondral fragment can be considered in special situations.
Formosan Journal of Musculoskeletal Disorders, 2011
Dislocation of the patella is not a common disorder of the knee joint and is seen most frequently in the adolescent population. Osteochondral fractures account for approximately 5-74% of all acute patellar dislocations and are easy to overlook. The mechanism of injury and presentations of fractured fragments were seldom well describe in published studies. The case reported here is that of a 17-year-old baseball player who suffered an acute patellar dislocation with a large osteochondral fragment fracture, where the fragment presented over the lateral supracondylar aspect of the distal femur. Open reduction and fixation with Kirschner wires gave a good result. Osteochondral fracture of patella is usually regarded as a dislocation phenomenon. However, we review and discuss here three injury mechanisms, and suggest the possible mechanisms by which patellar relocation could have caused our patient's injury and the rare occurrence of a laterally displaced osteochondral fragment over the distal femur.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2018
Although osteochondral fractures of the lateral femoral condyle are uncommon, fixation of the fragments is recommended, mostly when is about young athletes with such post-traumatic pathology. We present a case of a professional handball player teenager female, with a lateral femur condylar osteochondral fracture after a fall with the right knee in extension and in internal rotation. Magnetic resonance imaging (MRI) showed an osteochondral fracture of the lateral femoral condyle, 34.6 mm on long axis, impossible to manage arthroscopically, because of the size and the location of the detached fragment. The solution was the lateral knee arthrotomy allowing the evacuation of the hemarthrosis and preparation of the fracture site, then reduction and fixation of the fracture with absorbable cannulated pins. This procedure is of choice only when is enough bone in the detached fragment to permit the internal fixation and bone-to-bone healing with cartilaginous tissue stabilization through th...
A Rare Case of Large Osteochondral Fracture of Patella
Cureus
Osteochondral fractures of the patella are relatively common pediatric knee injuries, often missed during the initial evaluation, and almost always associated with acute patella dislocations. We report the case of an adolescent patient with a very large osteochondral fracture of the patella involving almost the whole of the medial patellar facet and without concomitant dislocation of the patella. A 16-year-old adolescent presented to the emergency with pain and swelling in the left knee after sustaining a road traffic accident. On evaluation with an X-ray and a CT scan, a large osteochondral fracture of the patella was diagnosed. The fracture was treated with open reduction and internal fixation with headless compression screws after performing medial parapatellar arthrotomy. After two years, the patient recovered with a full and painless range of movement of the knee, with the complete radiological union of the fracture. This case report discusses a rare case of an adolescent with a large osteochondral fracture of the patella without concomitant patella dislocation.
Large Isolated Anterior Osteochondral Fracture of the Medial Femoral Condyle: A Case Report
Shafa Orthopedic Journal, 2018
Introduction: Coronal plane Fractures of the femoral condyle are known as Hoffa fractures. Although isolated posterior Hoffa fractures of medial femoral condyle have been rarely reported, no reports are available regarding the anterior fracture of this type. Here, we report a large isolated anterior osteoarticular fracture of the medial femoral condyle. Case Presentation: A 16-year-old girl with a traumatic open joint injury of the right knee caused by a car-to-pedestrian accident was referred to our emergency department for further evaluation. A physical examination of the knee revealed effusion and limited knee range of motion. While no obvious fracture was detectable on plain radiographs of the knee, a large anterior osteoarticular fracture of the medial femoral condyle was observed in computed tomography (CT), which was detached from the medial condyle. The fracture was managed with open reduction and internal fixation. Eight weeks after the surgery, the patient retrieved the full knee motions and the complete union of the fracture was observed. No complication was reported by the patient at a follow-up period of 12 months. Conclusions: In cases with knee tenderness and/or effusion and normal plain radiographs, whenever there is a discrepancy between plain radiographs and clinical symptoms of the patient, a further evaluation of the knee with a CT scan and/or MRI is necessary to avoid missing a Hoffa fracture, which could be successfully treated if timely diagnosed.
Case reports in orthopedics, 2013
Traumatic dislocation of the patella is classified as lateral, medial, or intra-articular according to the direction of dislocation. Lateral dislocation is the most common type of patellar dislocation, and intra-articular dislocation is rare. Intra-articular dislocation is classified as superior, inferior, or vertical dislocation. Inferior dislocation is categorized as Type I, which occurs in young people, and Type II, which occurs in the elderly. In Type II, osteophytes on the superior pole of the patellar are believed to become entrapped in the intercondylar notch, dislocating the patella inferiorly. These were two extremely rare cases of inferior dislocation of the patella in elderly people. The mechanism involved was considered to be the exertion of sudden upward traction on the patella due to the muscular force of the quadriceps when the knee was flexed, causing osteophytes on the superior pole of the patella to become impacted into the femoral trochlea. Dislocations were succe...
Osteochondritis dissecans of the lateral femoral condyle in the adult
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 1992
In osteochondritis dissecans, 15% of the lesions occur in the lateral condyle. In order to understand the significance of these lesions, 27 were studied prospectively from 1983 to 1990 and compared with 20 consecutive cases of lesions of the medial femoral condyle. Lesions of the lateral femoral condyle were larger, and often comprised the entire width of a condyle and resulted in deformation of a significant segment of the femoral condyle. They lay further posteriorly and commonly were associated with mechanical symptoms including buckling or locking. A discernible clunk was unique to these lesions. In addition, lateral lesions were more fragile, often having multiple bony islands that were prone to fragmentation, making replacement difficult if not impossible. Lateral lesions occurred directly within the main force-bearing areas of the condyle, disrupting normal contact areas and possibly leading to more rapid joint deterioration once segments are lost. This has prompted concern for reinsertion of articular fragments or reconstruction with osteochondral allografts.
Bilateral osteochondrosis of lateral femoral condyles: case report and literature review
Revista brasileira de reumatologia, 2012
Osteochondrosis is an injury on subchondral ossification with predominance of immature skeleton and whose etiology remains unknown. It may affect the femoral condyles (usually the medial condyle) and the involvement is mostly unilateral. The authors draw the attention to this usually late diagnosis due to its infrequent occurrence and report a child's rare case of bilateral osteochondrosis on lateral femoral condyles, stressing that just one similar case has been described in the orthopaedic literature up to the present time.