ABSTRACT
Las fracturas osteocondrales (FOC) traumáticas de rodilla en la edad pediátrica, son lesiones que acompañan hasta un 30% de las luxaciones agudas de rótula (LAR). Si no se mantiene una elevada sospecha clínica, es frecuente su retraso diagnóstico, pudiendo generar potenciales complicaciones. A propósito, presentamos el caso de una paciente de 12 años con una FOC post LAR que pasó inadvertida en la primera consulta, requiriendo la fijación del fragmento osteocondral con tornillos HCS a los 5 meses, logrando un excelente resultado funcional a los 54 meses de seguimiento.
Traumatic osteochondral fractures (OCF) of the knee in pediatric age are injuries that accompany up to 30% of acute patellar dislocations (APD). If high clinical suspicion is not maintained, its diagnostic delay is frequent, and may generate potential complications. Incidentally, we present the case of a 12-year-old patient with a post-APD OCF that went unnoticed in the first consultation, requiring fixation of the osteochondral fragment with HCS screws at 5 months. Achieving an excellent functional result at 54 months follow-up.
As fraturas osteocondrais traumáticas (FOC) do joelho em idade pediátrica são lesões que acompanham até 30% das luxações agudas da patela (LAP). Se uma alta suspeita clínica não for mantida, seu atraso no diagnóstico é frequente e pode gerar complicações potenciais. A propósito, apresentamos o caso de um paciente de 12 anos com FOC pós-LAP que passou despercebido na primeira consulta, exigindo fixação do fragmento osteocondral com parafusos HCS em 5 meses. Obtendo um excelente resultado funcional aos 54 de acompanhamento.
Subject(s)
Humans , Female , Child , Knee Injuries/surgery , Knee Injuries/diagnostic imaging , Bone Screws , Magnetic Resonance Imaging , Follow-Up Studies , Treatment Outcome , Patellar Dislocation/complications , Fracture Fixation , Knee Injuries/etiologyABSTRACT
<p><b>Background</b>Patellar dislocation is one of the most common knee injuries in the adolescent population. It is often combined with osteochondral fracture. The purpose of this study was to compare the outcomes between fixation and excision of osteochondral fractures not involving the bearing surface in adolescent patients with patellar dislocations.</p><p><b>Methods</b>Patients who underwent surgery for osteochondral fracture following patellar dislocation in our institution from 2007 to 2014 were retrospectively evaluated. Visual analog scale (VAS) of pain and the International Knee Documentation Committee (IKDC) form were used to assess knee pain and function at follow-up. Patient satisfaction was evaluated. Differences in the values of variables among groups were assessed using t-test if equal variance or Mann-Whitney U-test if not equal variance. The Pearson's Chi-square test was applied for dichotomous variables if expected frequency was >5 or Fisher's exact test was applied if not. A value of P < 0.05 was considered statistically significant.</p><p><b>Results</b>Forty-three patients were included, with the average age of 14.1 ± 2.3 (range, 9.0-17.0) years. Nineteen underwent fixation of osteochondral fractures and 24 did not. The average follow-up time was 28 ± 10 months. There was no significant difference in age, gender, follow-up time, causes of injury, times of dislocation, and location of osteochondral fracture between fixation and excision groups. The fixation group had a significantly longer surgery time (82 ± 14 min) and larger size of osteochondral fracture (2.30 ± 0.70 cm) than the excision group (43 ± 10 min, 1.88 ± 0.62 cm, respectively, t = 10.77, P < 0.01 and t = 0.84, P < 0.05). At the last follow-up, the average IKDC score in the fixation group (82.52 ± 8.71) was significantly lower than that in the excision group (89.51 ± 7.19, t = 2.65, P < 0.01). There was no significant difference in VAS of pain and patients' satisfaction. There were 7 (16%) patients with recurrent dislocation.</p><p><b>Conclusion</b>Excision of osteochondral fractures has equivalent or better outcomes compared to fixation in adolescent patients with patellar dislocations when these fractures do not involve the bearing surface.</p>
Subject(s)
Adolescent , Child , Female , Humans , Male , Femoral Fractures , General Surgery , Knee Injuries , General Surgery , Patellar Dislocation , General Surgery , Retrospective StudiesABSTRACT
Capitellar osteochondral impaction fractures of the humerus are an uncommon injury and not encompassed by commonly used classification systems, such as that of Bryan and Morrey. Only a few cases of capitellar osteochondral impaction fractures have been reported. We report a case of a 53-year-old female with a capitellar osteochondral impaction fracture. The osteochondral fracture fragment of the capitellum was impacted and there was a step-off on the articular surface. Recovery of congruence in the capitellar articular surface was necessary. Satisfactory clinical and radiological results were obtained through the ‘lever arm’ reduction of the fracture fragment with a small osteotome and fixation with ‘raft’ K-wire.
Subject(s)
Adult , Female , Humans , Middle Aged , Classification , HumerusABSTRACT
Objective To investigate the value of MRI diagnosis in tangential osteochondral fracture.Methods 1 7 patients with tangential osteochondral fracture were examined by MRI,and the related signs were analyzed,including the subluxation or disloca-tion of patellofemoral joint,the injury or fracture of bone and cartilage,the injury of meniscus,the injury of medial patella retinacu-lum and ligament,the effusion articular capsule.we investigated the role of X-ray film,CT,MRI,compared with arthroscopy.Re-sults MRI showed subluxation of patellofemoral joint(Ⅰtype 12 cases、Ⅱtype 3 cases、Ⅲ type 1 case)in 1 6 cases,1 case had mild move of patella.All of 1 7 cases were found fracture in bone or cartilage of the inferior medial part of patella and the anterior lateral part of lateral femoral condyle.All cases were found the injury of medial patella retinaculum(Ⅰtype 7 cases、Ⅱtype 9 cases、Ⅲ type 1 case),3 cases were found the injury of MCL,2 cases were found the injury of ACL.3 cases were found the injury or tear in anteri-or horn of meniscus.1 1 cases were found articular capsule filling with simple effusion,5 cases were found articular capsule filling with hemorrhagic effusion,1 case was found articular capsule filling with hemorrhagic effusion and fat granule.Conclusion MRI can clearly show tangential osteochondral fracture and its accompanying changes:the subluxation or dislocation of patellofemoral joint, the injury or fracture of bone and cartilage,the injury of meniscus,the injury of medial patella retinaculum and other ligament,the articular capsule effusion.
ABSTRACT
A new fibrinogen system, consisting of highly concentrated fibrinogen and thrombin, is going to be applied in many clinical fields. Especially in injuries of the cartilagenous joint surface as chondral or osteochondral fractures, replantation of the fragments must be considered mandarory in order to preserve joint congruence and to prevent further destruction of the articular cartilage. The authors have an encouraging results by using this fibrin adhesive system (F.A.S.) in the experimental works.