Neglected Pediatric Osteochondral Fracture Dislocation of the Patella

Abstract

Pediatric osteochondral fracture dislocation of the patella is sometimes difficult to diagnose on the basis of physical examination or plain film radiography. Magnetic resonance imaging plays an important role in its early diagnosis, and early treatment can prevent damage to the articular cartilage as well as decrease the dislocation rate. Currently, many treatment choices have been reported with good results, but there is no consensus on which treatment option may lead to the best outcome. Herein, we describe the case of a 14-year-old girl with neglected osteochondral fracture dislocation of the patella. The outcome was optimal on the basis of a 2-year postoperative follow-up; thus, we believe that fixation with headless screws is a simple and effective method if the fracture fragment is large enough.

Chronic Osteochondral Fractures of the Patella Managed with Open Reduction and Internal Fixation Yields Excellent Knee Function

“…In 1988, Rae and Khasawneh 17 were the first to successfully use headless cannulated compression screws to fix large osteochondral fragments of the patella. Other authors [7][8][9]18,19 have reported small series of cases and case reports, showing excellent outcomes in acute OCFs managed by ORIF with screw fixation. Gesslein et al, 20 in a series of 36 acute OCFs located on the patellar surface, concluded that fixation shows improved clinical outcomes and is superior as compared with debridement.…”

“…The current literature regarding the management of acute patellar dislocation complicated by OCF consists mostly of case reports and small case series that report the results of various methods of osteochondral fragment fixation or excision. 3 4 5 6 7 8 9 The effect of time on the results of fixation is an essential question that remains unanswered. 4 With no established guidelines, management of chronic OCF remains debatable, yet intriguing.…”

Neural Network Algorithm MRI Images for Analysis of Influencing Factors for Patellar Dislocation in Exercise

“…e chief symptoms include pain, swelling, restricted movement, and joint hydrops of knee joints [1]. e common APD imaging examination methods cover the X-ray, CT, and magnetic resonance imaging (MRI) examinations [2]. As compared with ordinary X-ray and CT examination, the MRI examination is featured by no radiation, multiparameter imaging, and high resolution for soft tissue, and it can obtain the different degrees of damage to bone, cartilage, synovium, ligament and other tissues, the extension and degree of the bone contusion, bone marrow edema and osteochondral damage of the patellofemoral joint, and the injury location and extent of the medial retaining ligament and medial collateral ligament of patella through a single scanning.…”

One-Stage Osteochondral Fracture Repair Technique With Knotless Anchors and Interconnected Crossing Suture Sliding Loops for the Knee

“…Classically, the treatment of OCFs include osteosynthesis of the fragment with different devices described in the literature, such as standard compression screws, headless compression screws, Herbert screws, bioabsorbable screws and pins, meniscus arrows, or sutures passed through complete bone tunnels. [6][7][8][9][10][11][12][13][14][15][16][17][18] Occasionally, when the subchondral bone or the fragment is too small for fixation or chronic, it has to be removed and managed with cartilage restorative techniques, such as debridement and/or micro/nanofractures, autologous chondrocyte implantation/ matrix-induced chondrocyte implantation, mosaicplasty, bone grafts and scaffolds, biomaterials or fresh osteochondral allograft, depending on the size and depth of injury. [19][20][21][22][23] The purpose of this Technical Note is to describe the one-stage osteochondral fracture repair technique with knotless anchors and interconnected crossing suture sliding loops, with no complete bone tunnels, no need for a second-stage surgery hardware removal, and suitable in certain cases (Table 1) and for different anatomic locations, such as patella, condyle, or trochlea defects.…”

“…Classically, the treatment of OCFs include osteosynthesis of the fragment with different devices described in the literature, such as standard compression screws, headless compression screws, Herbert screws, bioabsorbable screws and pins, meniscus arrows, or sutures passed through complete bone tunnels. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 …”