Osteochondral Fracture of the Patella Associated with Patellofemoral Dislocation: Case Report
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Abstract
Summary Traumatic osteochondral fractures in pediatric patients are associated with patellofemoral dislocations in a high percentage (18–75%). Clinical presentation is variable, so maintaining a high index of clinical suspicion is important for better diagnosis, treatment, and outcomes. Accordingly, we present the case of a 12-year-old patient with an osteochondral fracture of the patella associated with a patellofemoral dislocation. The treatment was surgical, involving osteosynthesis with HCS screws, resulting in an excellent functional outcome at 3 years of follow-up.
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References
Vaquero J, Vidal C, Cubillo A. Intra-articular traumatic disorders of the knee in children and adolescents. Clin Orthop Relat Res. 2005;(432):97–106.
Milgram J. Tangential osteochondral fracture of the patella. J Bone Jt Surg. 1943;25(2):271–80.
JS. B. Osteochondral fracture of the patella. Proc R Soc Med. 1948;41:853.
Isacsson A, Olsson O, Englund M, Frobell RB. Incidence and concomitant chondral injuries in a consecutive cohort of primary traumatic patellar dislocations examined with sub-acute MRI. Int Orthop [Internet]. 2023;47(4):973–81. Available from: https://doi.org/10.1007/s00264-023-05707-y
Kramer DE, Pace JL. Acute Traumatic and Sports-Related Osteochondral Injury of the Pediatric Knee. Orthop Clin North Am [Internet]. 2012;43(2):227–36. Available from: http://dx.doi.org/10.1016/j.ocl.2012.02.001
Zionts LE. Fractures around the knee in children. [Internet]. Sixth Edit. Vol. 10, The Journal of the American Academy of Orthopaedic Surgeons. Elsevier Inc.; 2002. 345–355 p. Available from: https://doi.org/10.1016/B978-0-323-61336-1.00013-3
Devgan A, Batra A, Rohilla R, Jain A, Singh S, Arora S, et al. Traumatic isolated osteochondral fractures of medial femoral condyle treated with multiple retrograde Kirschner wires – A simple cost-effective technique. J Arthrosc Jt Surg [Internet]. 2016;3(2):61–5. Available from: http://dx.doi.org/10.1016/j.jajs.2016.07.003
Enea D, Busilacchi A, Cecconi S, Gigante A. Late-diagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: A case report. J Pediatr Orthop Part B. 2013;22(4):344–9.
Chotel F, Knorr G, Simian E, Dubrana F, Versier G. Knee osteochondral fractures in skeletally immature patients: French multicenter study. Orthop Traumatol Surg Res. 2011;97(8 SUPPL.):154–9.
Seeley MA, Knesek M, Vanderhave KL. Osteochondral injury after acute patellar dislocation in children and adolescents. J Pediatr Orthop. 2013;33(5):511–8.
Bauer KL. Osteochondral Injuries of the Knee in Pediatric Patients. J Knee Surg. 2018;31(5):382–91.
Lee BJ, Christino MA, Daniels AH, Hulstyn MJ, Eberson CP. Adolescent patellar osteochondral fracture following patellar dislocation. Knee Surgery, Sport Traumatol Arthrosc. 2013;21(8):1856–61.
Kang H, Li J, Chen XX, Wang T, Liu SC, Li HC. Fixation versus Excision of Osteochondral Fractures after Patellar Dislocations in Adolescent Patients: A Retrospective Cohort Study. Chin Med J (Engl). 2018;131(11):1296–301.
Krause EA, Lin CW, Ortega HW, Reid SR. Pediatric lateral patellar dislocation: Is there a role for plain radiography in the emergency department? J Emerg Med [Internet]. 2013;44(6):1126–31. Available from: http://dx.doi.org/10.1016/j.jemermed.2012.11.014
Askenberger M, Ekström W, Finnbogason T, Janarv PM. Occult Intra-articular knee injuries in children with hemarthrosis. Am J Sports Med. 2014;42(7):1600–6.
Masquijo JJ, Viola MA, Narbona P, Allende GJ. Hallazgos por Resonancia Magnética ( RMN ) en Pacientes Esqueléticamente Inmaduros con Primer Episodio de Luxación Aguda de Rótula . 2012;19(January):132–6.
Gkiokas A, Morassi LG, Kohl S, Zampakides C, Megremis P, Evangelopoulos DS. Bioabsorbable Pins for Treatment of Osteochondral Fractures of the Knee after Acute Patella Dislocation in Children and Young Adolescents. Adv Orthop. 2012;2012:1–4.
Scott I&. Disorders of the patellofemoral joint. In: Surgery of the Knee. 2018. p. 843–84.
Seeley M, Bowman KF, Walsh C, Sabb BJ, Vanderhave KL. Magnetic Resonance Imaging of Acute Patellar Dislocation in Children. J Pediatr Orthop. 2012;32(2):145–55.
Kocher MS, Smith JT, Iversen MD, Brustowicz K, Ogunwole O, Andersen J, et al. Reliability, validity, and responsiveness of a modified international knee documentation committee subjective knee form (Pedi-IKDC) in children with knee disorders. Am J Sports Med. 2011;39(5):933–9.
Herrera Rodríguez JS, Ponce de León MC, Castañeda JF, Yela H, Díaz A. Validación y adaptación transcultural de la escala Pedi-IKDC para la evaluación funcional de niños llevados a cirugía de rodilla. Rev Esp Cir Ortop Traumatol. 2022;66(6):500–3.
Broom ND, Oloyede A, Flachsmann R, Hows M. Dynamic fracture characteristics of the osteochondral junction undergoing shear deformation. Med Eng Phys. 1996;18(5):396–404.
Walsh SJ, Boyle MJ, Morganti V. Large osteochondral fractures of the lateral femoral condyle in the adolescent: Outcome of bioabsorbable pin fixation. J Bone Jt Surg - Ser A. 2008;90(7):1473–8.
Flachsmann R, Broom ND, Hardy AE, Moltschaniwskyj G. Why is the adolescent joint particularly susceptible to osteochondral shear fracture. Clin Orthop Relat Res. 2000;(381):212–21.
D A, M.m M, E.j W, G C, S.n P. {MRI} findings in adolescent patients with acute traumatic knee hemarthrosis. J Pediatr Orthop. 2012;32(8):760–4.
Wessel LM, Scholz S, Rüsch M, Köpke J, Loff S, Duchêne W, et al. Hemarthrosis after trauma to the pediatric knee joint: What is the value of magnetic resonance imaging in the diagnostic algorithm? J Pediatr Orthop. 2001;21(3):338–42.
Lewallen LW, McIntosh AL, Dahm DL. Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients. Am J Sports Med. 2013;41(3):575–81.
Lee DY, Park YJ, Song SY, Hwang SC, Park JS, Kang DG. Which Technique Is Better for Treating Patellar Dislocation? A Systematic Review and Meta-analysis. Arthrosc - J Arthrosc Relat Surg [Internet]. 2018;34(11):3082-3093.e1. Available from: https://doi.org/10.1016/j.arthro.2018.06.052