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Nudelman H, Lőrincz A, Lamberti AG, Varga M, Kassai T, Józsa G. Management of Juvenile Osteochondral Fractures Utilising Absorbable PLGA Implants. J Clin Med 2024; 13:375. [PMID: 38256509 PMCID: PMC10816157 DOI: 10.3390/jcm13020375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
The incidence of articular injury, particularly osteochondral fractures (OCFs), has seen a cinnotable increase in recent years. Regardless of their location, fragments can be overlooked by plain radiographs, which might lead to osteoarthritis in the long run. Diagnostic imaging has a pivotal role in the assessment and classification of the fracture severity, as well as the presence of any associated dislocations. These fractures require surgical intervention for the restoration of joint function and the reduction of long-term complications. This paper aims to present the surgical correction and post-operative treatment of osteochondral fractures with absorbable implants in four children. The following affected areas are discussed: lateral condyle of the femur, patella and radial head. Utilising absorbable implants for the management of OCFs provides numerous advantages, including the elimination of the need for re-anaesthesia and reoperation, reduction of complications and facilitation of early rehabilitation. This approach also minimises the period of hospitalisation and proves effective in pediatric OCF treatment.
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Affiliation(s)
- Hermann Nudelman
- Division of Surgery, Traumatology and Otorhinolaryngology, Department of Paediatrics, Clinical Complex, University of Pécs, 7 József Attila Street, 7623 Pécs, Hungary
| | - Aba Lőrincz
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, 7624 Pécs, Hungary
| | - Anna Gabriella Lamberti
- Division of Surgery, Traumatology and Otorhinolaryngology, Department of Paediatrics, Clinical Complex, University of Pécs, 7 József Attila Street, 7623 Pécs, Hungary
| | - Marcell Varga
- Department of Pediatric Traumatology, Péterfy Hospital, Manninger Jenő National Trauma Center, 17 Fiumei Street, 1081 Budapest, Hungary
| | - Tamás Kassai
- Department of Pediatric Traumatology, Péterfy Hospital, Manninger Jenő National Trauma Center, 17 Fiumei Street, 1081 Budapest, Hungary
| | - Gergő Józsa
- Division of Surgery, Traumatology and Otorhinolaryngology, Department of Paediatrics, Clinical Complex, University of Pécs, 7 József Attila Street, 7623 Pécs, Hungary
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, 7624 Pécs, Hungary
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Koskiniotis AE, Stefanou N, Metaxiotis N, Amprazis V, Varitimidis S. Pediatric Knee Injury: A Unique Case of Intra-articular Osteochondral Fracture Following Penetrating Trauma. Cureus 2024; 16:e53236. [PMID: 38425623 PMCID: PMC10903575 DOI: 10.7759/cureus.53236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Penetrating injuries to the musculoskeletal system pose common challenges for orthopedic surgeons in emergency departments (EDs). The complexity escalates when a joint is affected, increasing the risk of severe complications such as infection and post-traumatic arthritis. Given the potential importance of these injuries, early diagnosis and a meticulous treatment plan are crucial. In this paper, we present a unique case of penetrating trauma, resulting in an intra-articular defect on the lateral femoral condyle of an adolescent girl. This case underscores the importance of tailored interventions in managing complex musculoskeletal injuries.
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Affiliation(s)
- Alexandros E Koskiniotis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, GRC
| | - Nikolaos Stefanou
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, GRC
| | - Nikolaos Metaxiotis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, GRC
| | - Vasileios Amprazis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, GRC
| | - Sokratis Varitimidis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, GRC
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3
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Wilson PL, Wyatt CW, Johnson BL, Carpenter CM, Ellis HB. Suture-Bridge Fixation of Osteochondral Fractures and Osteochondritis Dissecans in the Knee: Excellent Rates of Early Lesion Stability and Osseous Union. Am J Sports Med 2023; 51:2936-2944. [PMID: 37565525 DOI: 10.1177/03635465231189244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND Preservation of articular cartilage in the setting of acute or chronic injury in the adolescent and young adult knee is paramount for long-term joint health. Achieving osseous union, minimizing implant-related injury, and eliminating the need for reoperation for traumatic chondral and osteochondral lesions (OCLs) and osteochondritis dissecans (OCD) remain a challenge for the orthopaedic surgeon. PURPOSE To evaluate radiographic healing, patient-reported outcomes, and short-term complications after suture-bridge fixation of chondral fragments, osteochondral fractures, and OCD lesions in the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS The study included consecutive patients (38 patients, 40 knees) treated within a single academic sports medicine institution who underwent suture-bridge fixation of an OCL or an OCD lesion of the knee from initiation of the technique in October 2019 through March 2021. The suture-bridge technique entailed bioabsorbable knotless anchors placed on the outside margins of the lesion with multiple strands of hand-tensioned absorbable (No. 0 or No. 1 Vicryl) or nonabsorbable (1.3-mm braided polyester tape) bridging suture. Healing was assessed by radiography and magnetic resonance imaging (MRI), with MRI scans obtained on all OCD lesions and any chondral-only lesions. MRI scans were available for 33 of 40 (82.5%) knees within 1 year of surgery and were evaluated for lesion healing. Complications and rates and timing of return to sport were evaluated. Patient-reported outcomes in the OCD cohort were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) to determine early pain and functional improvement. RESULTS In total, 33 (82.5%) lesions demonstrated full union, and no lesions failed treatment. MRI assessment of healing (mean, 5.8 months; range, 3-12 months) demonstrated 9 (64.3%) OCD lesions with full union, 5 (35.7%) OCD lesions with stable union, and no OCD lesions with nonunion. Of the OCLs, 17 (89.5%) had full union, 2 (10.5%) had stable union, and none had nonunion. The 7 bony OCLs without an MRI scan demonstrated complete radiographic union. In 30 (75.0%) lesions, patients returned to sports at a mean of 6.5 months (range, 3.8-10.2 months). KOOS Activities of Daily Living, Pain, Quality of Life, and Symptoms scores demonstrated significant improvement from baseline at 6 months and at 1 year. There were 2 (5%) complications, consisting of reoperation for marginal chondroplasty on an otherwise stable lesion, and re-operation for intial un-treated patellar instability, with no reoperations for failure or revision of the suture-bridge construct. CONCLUSION In this series of OCLs and OCD lesions of the knee, suture-bridge fixation demonstrated excellent rates of MRI and radiographic union and good early outcomes with minimal short-term complications. This technique may be used for lesion salvage as an alternative to metallic and nonmetallic screw/tack constructs in the treatment of these challenging lesions. Longer term follow-up and investigation are warranted.
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Bansal S, Choudhury AK, Barman S, Niraula BB, Raja BS, Kalia RB. Medial Patellofemoral Ligament Tear Associated with an Intra-articular Axial Spilt Osteochondral Fracture of the Lateral Femoral Condyle: a "Knee Trap-door" Fracture. J Orthop Case Rep 2023; 13:52-56. [PMID: 37654742 PMCID: PMC10465732 DOI: 10.13107/jocr.2023.v13.i08.3814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Medial patellofemoral ligament (MPFL) prevents lateral dislocation of the patella and acts as a major stabilizer. The tear could be associated with osteochondral avulsion fractures; however, intra-articular split fractures are not seen. Here, we present one unusual case of such a presentation. Case Report A 16-year-old male presented with a history of recurrent patellar dislocation and inability to bear weight following the last episode. The patient was diagnosed with an MPFL tear with an unusual intra-articular femoral condyle split fracture. The case had significant improvement in functional scores post-surgery. Conclusion In physically active populations, twisting of the knee could result in an MPFL tear, leading to recurrent patellar dislocation. The treatment remains ligament reconstruction, open, or arthroscopic. Associated intra-articular fractures are very rare with such injuries and need to be addressed due to the high rate of non-union.
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Affiliation(s)
- Shivam Bansal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Arghya Kundu Choudhury
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Saptarshi Barman
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bishwa Bandhu Niraula
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Balgovind S Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Wu L, Liu C, Jiang B, He L. Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report. Medicine (Baltimore) 2022; 101:e32104. [PMID: 36550860 PMCID: PMC9771171 DOI: 10.1097/md.0000000000032104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Osteochondral fracture (OCF) in weight-bearing area of lateral femoral condyle (LFC) is a rare combined injury caused by patellar dislocation. PATIENT CONCERNS A 15-year-old female student accidentally sprained her right knee while participating in sports activities. The patient felt pain in his right knee and limited movement. After hospitalization, the patients underwent computed tomography scan and magnetic resonance examination. DIAGNOSIS According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. INTERVENTIONS Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. OUTCOMES The functional and radiographic outcome were satisfactory at 18 months after operation. LESSONS Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical.
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Affiliation(s)
- Liang Wu
- Department of Orthopedic Surgery, First People’s Hospital of Linpin District, Hangzhou, Zhejiang, China
| | - Chao Liu
- Department of General Surgery, Medicine Faculty of Universitas Prima Indonesia, North Sumatra, Indonesia
| | - Bing Jiang
- Department of General Surgery, Daocheng Country People’s Hospital, Sichuan, China
| | - Lijiang He
- Department of Orthopedic Surgery, Second People’s Hospital of Yuhang District, Hangzhou, Zhejiang, China
- * Correspondence: Lijiang He, Department of Orthopedic Surgery, Second People’s Hospital of Yuhang District, Hangzhou, Hangzhou, Zhejiang 311121, China (e-mail: )
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Felus J, Kowalczyk B, Starmach M, Wyrobek L. Osteochondral Fractures in Acute Patellar Dislocations in Adolescents: Midterm Results of Surgical Treatment. Orthop J Sports Med 2022; 10:23259671221107608. [PMID: 35859644 PMCID: PMC9289920 DOI: 10.1177/23259671221107608] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Osteochondral fractures (OCFs) are common injuries during acute patellar
dislocation (APD), carrying a high risk of early joint deterioration if left
untreated. The recommended approach is reduction and stable fixation;
however, data on the results of such treatment are limited. Purpose: To evaluate midterm results of fixation of APD-related OCFs in adolescents
and to identify predictive factors for poor outcomes. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective analysis of adolescent patients who underwent
internal fixation of APD-related OCFs between 2004 and 2015 at a single
tertiary pediatric trauma center. The primary outcome variables included
Knee injury and Osteoarthritis Outcome Score (KOOS), patient satisfaction
(0-10 scale), and sports participation compared with preoperative level.
Secondary outcome variables included relationship between final results and
OCF location (patellofemoral vs tibiofemoral), surgical delay (>6 weeks),
and patellar instability after OCF fixation. OCF healing was evaluated using
magnetic resonance imaging (MRI). Results: Included were 40 patients (19 female, 21 male) with 42 OCFs (29 patellar
OCFs, 13 lateral femoral condyle OCFs). The median patient age at surgery
was 14.5 years (interquartile range [IQR], 13-15.5 years), and median
follow-up was 76 months (IQR, 52.5-95 months). Recurrence of patellar
instability occurred in 27.5% of patients. Median overall KOOS was 93.8
(IQR, 90.8-97.6); KOOS–Symptoms, 92.9 (IQR, 85.7-96.4); KOOS–Pain, 97.2
(IQR, 91.7-100); KOOS–Activities of Daily Living, 100 (IQR, 97.1-100);
KOOS–Sports, 90 (IQR, 80-100); and KOOS–Quality of Life, 78.1 (IQR,
56.2-87.5). Median satisfaction score was 8 (IQR, 8-9), and 16 patients
(40%) returned to sports participation at their preinjury level. MRI scans
revealed a 100% rate of bone healing. Abnormalities exceeding the fracture
area were evident on MRI scans in 86.5% of patients. Recurrence of patellar
instability (even after surgical fixation) and unstable patella at final
follow-up were independent predictors of worse results after OCF
fixation. Conclusion: In the current study, reduction and internal fixation for APD-related OCF in
adolescents yielded favorable midterm outcomes. Recurrence of dislocation
and persistent patellar instability jeopardized clinical results.
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Affiliation(s)
- Jaroslaw Felus
- Pediatric Orthopedics and Trauma Surgery Department, University Children's Hospital, Krakow, Poland
| | - Bart Kowalczyk
- Pediatric Orthopedics and Trauma Surgery Department, University Children's Hospital, Krakow, Poland
| | - Michal Starmach
- Pediatric Orthopedics and Trauma Surgery Department, University Children's Hospital, Krakow, Poland
| | - Lukasz Wyrobek
- Pediatric Orthopedics and Trauma Surgery Department, University Children's Hospital, Krakow, Poland
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Ackermann J, Waltenspül M, Merkely G, Germann C, Villefort C, Aufdenblatten C, Fucentese SF. Association of Subchondral Changes With Age and Clinical Outcome in Patients With Osteochondral Fractures in the Knee: MRI Analysis at 1 to 10 Years Postoperatively. Orthop J Sports Med 2022; 10:23259671221113234. [PMID: 35912386 PMCID: PMC9326836 DOI: 10.1177/23259671221113234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Predictive factors influencing outcomes after surgical fixation of osteochondral fractures (OCFs) in the knee, particularly time between injury and surgery, have not been determined. Purpose: To report imaging and clinical outcomes after OCF fixation and to assess the association between clinical scores and patient characteristics, lesion morphology, and appearance on magnetic resonance imaging (MRI) scans. Study Design: Case series; Level of evidence, 4. Methods: We assessed the clinical and imaging outcomes of 19 patients after screw fixation for OCFs in the knee at a minimum follow-up of 1 year. Patient characteristics, lesion morphology, and time from trauma to surgery were reviewed for each patient. At final follow-up, patients completed a 100-point visual analog scale (VAS) for pain, Tegner activity scale, Knee injury and Osteoarthritis Outcome Score (KOOS), and patient satisfaction survey. Postoperative MRI scans were assessed using the MOCART (magnetic resonance observation of cartilage repair tissue), Osteochondral Allograft MRI Scoring System, and bone marrow edema (BME) size. Results: The mean patient age at surgery was 21.3 ± 11.4 years, and the median time from trauma to surgery was 10 days (range, 0-143 days). The refixed OCF fragment failed in 1 (5.3%) patient on the lateral condyle at 15 months postoperatively. The mean follow-up for the remaining 18 patients was 4.7 ± 3.2 years, and postoperative outcomes were as follows: VAS pain score, 9.5 ± 17.9; Tegner score, 4.8 ± 2.3; KOOS–Pain, 85.9 ± 17.6, KOOS-Symptoms, 76.4 ± 16.1; KOOS–Activities of Daily Living, 90.3 ± 19.0; KOOS–Sport, 74.4 ± 25.4; and KOOS–Quality of Life, 55.9 ± 24.7. Overall, 84.2% were satisfied or very satisfied with outcomes. Patient age was significantly associated with KOOS subscale scores and subchondral imaging parameters including BME and presence of subchondral cysts, which in turn were the only imaging variables linked to clinical outcomes (P < .05). Time from injury to surgery was not correlated with clinical or imaging outcomes. Conclusion: Fixation of OCFs yielded acceptable clinical and imaging outcomes at a mean 5-year follow-up with seemingly little influence of delayed surgical treatment. Postoperative subchondral changes were significantly associated with clinical outcomes and were linked to patient age at surgery.
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Affiliation(s)
- Jakob Ackermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Clinic for Orthopaedics and Traumatology, Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph Germann
- Department of Radiology, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Christina Villefort
- Department of Pediatric Surgery, Division of Trauma and Orthopedic Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christoph Aufdenblatten
- Department of Pediatric Surgery, Division of Trauma and Orthopedic Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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8
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Gesslein M, Merkl C, Bail HJ, Krutsch V, Biber R, Schuster P. Refixation of Large Osteochondral Fractures After Patella Dislocation Shows Better Mid- to Long-Term Outcome Compared With Debridement. Cartilage 2021; 13:966S-973S. [PMID: 31718260 PMCID: PMC8808872 DOI: 10.1177/1947603519886637] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The purpose of this study was to compare results of osteochondral fractures (OCF) after first-time lateral patella dislocation, when either refixation or debridement was performed in a mid- to long-term follow-up and to analyze redislocation and reintervention rates. DESIGN Fifty-three consecutive patients with OCF were included in this retrospective comparative study. Indication for refixation was presence of subchondral bone at the fragment. Thirty-six OCF were located at the patellar surface, and 17 at the lateral condyle of the distal femur. Refixation was performed in 28 patients while 25 patients underwent removal and debridement. Mean follow-up was 8.9 years (±4.4, range 2.0-16.7 years). For assessment of clinical outcome, the International Knee Documentation Committee (IKDC) Score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score were used. Redislocation rate and further surgical interventions within follow-up were evaluated. RESULTS All clinical scores in the refixation group yielded significantly better results at mid- to long term follow-up (IKDC P < 0.001, KOOS P = 0.006, Lysholm P = 0.001). Significantly more surgical reinterventions were necessary after debridement (48% vs. 7.1%, P = 0.001). The overall redislocation rate in cases with medial reefing as single stabilizing procedure was 43.3%. CONCLUSIONS Refixation of OCF after lateral patella dislocation shows improved clinical outcome at mid- to long-term follow-up compared with debridement. Therefore, effort to try fragment refixation is recommended. Redislocation rate is high without proper restoration of patellofemoral instability.
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Affiliation(s)
- Markus Gesslein
- Department of Orthopedics and
Traumatology Klinikum Nuremberg, Paracelsus Private Medical University Nuremberg,
Nuremberg, Germany,Markus Gesslein, Paracelsus Private Medical
University Nuremberg, Breslauer Strasse 201, Nuremberg, 90471, Germany.
| | - Carolin Merkl
- Department of Orthopedics and
Traumatology Klinikum Nuremberg, Paracelsus Private Medical University Nuremberg,
Nuremberg, Germany
| | - Hermann Josef Bail
- Department of Orthopedics and
Traumatology Klinikum Nuremberg, Paracelsus Private Medical University Nuremberg,
Nuremberg, Germany
| | - Volker Krutsch
- Department of Otorhinolaryngology
Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg,
Germany
| | - Roland Biber
- Department of Traumatology, Klinken Dr.
Erler, Nuremberg, Germany
| | - Philipp Schuster
- Centre for Sports Orthopedics and
Special Joint Surgery, Orthopedic Hospital Markgroeningen, Markgroeningen,
Germany
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9
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Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. Orthop J Sports Med 2021; 9:2325967120974649. [PMID: 33553448 PMCID: PMC7841865 DOI: 10.1177/2325967120974649] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/02/2020] [Indexed: 01/08/2023] Open
Abstract
Background Literature describing the anatomic characteristics of osteochondral fractures (OCFs) in the knee joint after patellar dislocation is scarce. Purpose To describe the patterns of OCFs in the knee joint after acute or recurrent patellar dislocation in a sample of patients from 2 orthopaedic trauma centers. Study Design Case series; Level of evidence, 4. Methods In this multicenter study, all patients who had International Classification of Diseases, 10th Revision, diagnostic codes S83.0 and M22.0 between 2012 and 2018 were screened. Of the 2181 patients with clinically diagnosed patellar dislocation, 1189 had undergone magnetic resonance imaging (MRI). Patients with diagnosed patellar dislocation and osteochondral fragment verified on MRI scans were included. Demographic and clinical data were collected from electronic patient records. OCF location and size were assessed from MRI scans. Results were further compared in subgroups by sex, skeletal maturity, and primary versus recurrent patellar dislocation. Results An OCF was detected in 134 patients with injured knees, all of whom were included in the final analysis. It occurred in the patella in 63% of patients, in the lateral femoral condyle in 34%, and in both locations in 3%. The median OCF size was 146 mm2 (interquartile range, 105-262 mm2). There was no statistically significant difference in OCF size between patellar and lateral femoral condyle fractures. Patellar OCFs were more frequent in female than male patients (P = .009) and were larger after primary than recurrent dislocation (P = .040). Conclusion OCFs were mainly located in the medial facet of the patella and in the lateral femoral condyle, with these locations accounting for approximately two-thirds and one-third of all OCFs, respectively. Proportion of patellar OCF was higher in female than in male. Patellar OCFs may be larger after primary than recurrent dislocation.
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Affiliation(s)
- Mikko Uimonen
- Department of Surgery, Central Finland Hospital, Jyväskylä, Finland
| | | | - Juha Paloneva
- Department of Surgery, Central Finland Hospital, Jyväskylä, Finland.,University of Eastern Finland, Kuopio, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.,COXA Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heikki Nurmi
- Department of Surgery, Central Finland Hospital, Jyväskylä, Finland
| | - Jussi P Repo
- Department of Surgery, Central Finland Hospital, Jyväskylä, Finland
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10
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Schlechter JA, Nguyen SV, Fletcher KL. Utility of Bioabsorbable Fixation of Osteochondral Lesions in the Adolescent Knee: Outcomes Analysis With Minimum 2-Year Follow-up. Orthop J Sports Med 2019; 7:2325967119876896. [PMID: 31696131 PMCID: PMC6820181 DOI: 10.1177/2325967119876896] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Osteochondral lesions (OCLs) of the knee, whether occurring secondary to osteochondritis dissecans or a traumatic osteochondral fracture, are commonly encountered in the pediatric and adolescent population. Given the potential for healing in this population, coupled with adequate surgical reduction and stability of OCL fixation, an opportunity exists to avoid a major restorative procedure and the associated substantial costs and potential morbidity. Purpose: To analyze the outcomes of bioabsorbable fixation of OCLs in the adolescent knee at a minimum of 2 years. Study Design: Case series; Level of evidence, 4. Methods: An institutional review board–approved retrospective review was performed of patients younger than 18 years who underwent bioabsorbable fixation of an OCL of the knee with a minimum 2-year follow-up. Patient demographics, operative details, and postoperative clinical findings were detailed and recorded. All cases were performed by a single surgeon. Results: There were 38 patients treated surgically for an OCL between 2009 and 2016. Of these, 38 patients (mean age, 14.7 years) were evaluated at a mean of 59 months. OCL fixation consisted of a mean of 1.4 bioabsorbable screws and 1.5 darts. At final follow-up, mean pre- and postoperative Tegner scores were 6.6 and 6.4, respectively, while Lysholm and Pediatric International Knee Documentation Committee scores were 89.8 and 88.1, respectively. A total of 6 patients underwent secondary procedures postoperatively. One patient required a secondary procedure related to OCL fixation, which was secondary to a proud implant. The other secondary procedures included second-look arthroscopic surgery for pain after an injury postoperatively, planned anterior cruciate ligament reconstruction, staged medial patellofemoral ligament reconstruction, and manipulation under anesthesia for arthrofibrosis (n = 2). None of the 32 patients required a revision cartilage procedure at the time of final follow-up. Conclusion: The use of bioabsorbable implants in the adolescent knee appears to be a safe and efficacious treatment with good functional outcomes at long-term follow-up and a low revision rate. Additional long-term multisurgeon and multicenter trials with a larger cohort are needed to further elucidate the role of bioabsorbable fixation of an OCL in the adolescent knee.
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Affiliation(s)
- John A Schlechter
- Children's Hospital of Orange County, Orange, California, USA.,Riverside University Health System Medical Center, Moreno Valley, California, USA
| | - Shawn V Nguyen
- Riverside University Health System Medical Center, Moreno Valley, California, USA
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11
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Abstract
This article describes the case of an 18-year-old male after hip dislocation caused by snowboard injury, which resulted in osteochondral fracture of the head of femur with displacement of a loose body. CT as well as MRI confirmed the presence of a loose osteochondral fragment (20x14x4mm) fractured from the weight-bear-ing superoanterior part of head of femur (Pipkin type II). The surgical management undertaken was only arthroscopic, this representing a very rare case when com-par-ed to the literature. The article describes in detail the technical aspects of the procedure. At 4 months post-surgery, the replanted fragment had healed properly and the patient was pain-free and had the full range of movements. A low-invasive arthroscopic procedure is associated with less local tissue damage, reduced risk of infection and less blood loss. With this approach, it is possible to fix an osteochondral fragment without unnecessary defects in the cartilaginous surface.
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Affiliation(s)
- Jakub Sobczyk
- Carolina Medical Center, Warszawa, Polska / Carolina Medical Center, Warsaw, Poland
| | - Michał Drwięga
- Carolina Medical Center, Warszawa, Polska / Carolina Medical Center, Warsaw, Poland
| | - Jakub Banasiewicz
- Carolina Medical Center, Warszawa, Polska / Carolina Medical Center, Warsaw, Poland
| | - Jacek Laskowski
- Carolina Medical Center, Warszawa, Polska / Carolina Medical Center, Warsaw, Poland
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Izadi E, Anwar R, Phillips S, Kavarthapu V. Transmalleolar Approach for Arthroscopy-Assisted Headless Screw Fixation of an Osteochondral Talar Dome Fracture. J Foot Ankle Surg 2018; 57:622-626. [PMID: 29456078 DOI: 10.1053/j.jfas.2017.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Indexed: 02/03/2023]
Abstract
Displaced osteochondral fractures of the body of talus quite often require a malleolar osteotomy to gain access to the fracture fragment during internal fixation. We describe a case report in which access to a displaced osteochondral fracture of the lateral talar dome was achieved using an arthroscopy-assisted fibular tunnel approach. This technique resulted in satisfactory fracture healing and a satisfactory clinical outcome.
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Affiliation(s)
- Ebrahim Izadi
- Surgeon, Department of Trauma and Orthopaedics, King's College Hospital, London, UK.
| | - Rahij Anwar
- Surgeon, Department of Trauma and Orthopaedics, King's College Hospital, London, UK
| | - Sarah Phillips
- Surgeon, Department of Trauma and Orthopaedics, King's College Hospital, London, UK
| | - Venu Kavarthapu
- Surgeon, Department of Trauma and Orthopaedics, King's College Hospital, London, UK
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13
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Yano K, Kaneshiro Y, Sakanaka H. Isolated Osteochondral Fracture of the Trochlea in the Coronal Plane in a Child Before Ossification of the Trochlea: A Case Report and Literature Review. J Hand Surg Am 2018; 43:190.e1-190.e5. [PMID: 28811060 DOI: 10.1016/j.jhsa.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/07/2017] [Indexed: 02/02/2023]
Abstract
Isolated coronal shear fracture of the trochlea is a rare injury. Isolated fractures of the humeral trochlea have all been reported in adults. We present the case of a 7-year-old boy with pain and swelling of the elbow joint. Magnetic resonance imaging and arthrogram revealed an isolated osteochondral fracture of the trochlea in the coronal plane. Ossification of the trochlea had not yet occurred. An anterior approach was used for reduction and fixation of the fragment. A good clinical outcome was achieved with no signs of bony or chondral necrosis of the fragment 1 year after surgery.
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Affiliation(s)
- Koichi Yano
- Department of Orthopaedic Surgery, Seikeikai Hospital, Osaka, Japan.
| | | | - Hideki Sakanaka
- Department of Orthopaedic Surgery, Seikeikai Hospital, Osaka, Japan
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14
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Ek ET, Wang K. Fixation of Ultrasmall Proximal Pole Scaphoid Fractures Using Bioabsorbable Osteochondral Fixation Nails. J Hand Surg Am 2017; 42:758.e1-758.e4. [PMID: 28709792 DOI: 10.1016/j.jhsa.2017.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 06/12/2017] [Indexed: 02/02/2023]
Abstract
Surgical treatment of ultrasmall proximal pole scaphoid fractures poses a number of challenges. The fragment may be too small to fix with conventional headless screw fixation owing to the high risk of fragmentation upon insertion. However, excision of the fragment risks compromising the scapholunate ligament complex and also exposes the radioscaphoid joint to potential degenerative changes. Under these circumstances, we describe the use of bioabsorbable osteochondral fixation nails that allows stable low-profile fixation while minimizing the risk of fracturing the proximal pole.
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Affiliation(s)
- Eugene T Ek
- Division of Hand Surgery, Department of Orthopaedics, Dandenong Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia; Melbourne Orthopaedic Group, Windsor, Victoria, Australia.
| | - Kemble Wang
- Division of Hand Surgery, Department of Orthopaedics, Dandenong Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia; Melbourne Orthopaedic Group, Windsor, Victoria, Australia
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15
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H N, A P S, S B, A U, B K. Refixation of Osteochondral Fractures by an Ultrasound-Activated Pin System - An Ovine In Vivo Examination Using CT and Scanning Electron Microscope. Open Orthop J 2015; 9:7-14. [PMID: 25674184 PMCID: PMC4321208 DOI: 10.2174/1874325001509010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/04/2015] [Accepted: 01/07/2015] [Indexed: 11/22/2022] Open
Abstract
Background: Osteochondral injuries, if not treated appropriately, often lead to severe osteoarthritis of the affected joint. Without refixation of the osteochondral fragment, human cartilage only repairs these defects imperfectly. All existing refixation systems for chondral defects have disadvantages, for instance bad MRI quality in the postoperative follow-up or low anchoring forces. To address the problem of reduced stability in resorbable implants, ultrasound-activated pins were developed. By ultrasound-activated melting of the tip of these implants a higher anchoring is assumed. Aim of the study was to investigate, if ultrasound-activated pins can provide a secure refixation of osteochondral fractures comparing to conventional screw and conventional, resorbable pin osteosynthesis. CT scans and scanning electron microscopy should proovegood refixation results with no further tissue damage by the melting of the ultrasound-activated pins in comparison to conventional osteosynthesis. Methods: Femoral osteochondral fragments in sheep were refixated with ultrasound-activated pins (SonicPin™), Ethipins® and screws (Asnis™). The quality of the refixated fragments was examined after three month of full weight bearing by CT scans and scanning electron microscopy of the cartilage surface. Results: The CT examination found almost no statistically significant difference in the quality of refixation between the three different implants used. Concerning the CT morphology, ultrasound-activated pins demonstrated at least the same quality in refixation of osteochondral fragments as conventional resorbable pins or screws. The scanning electron microscopy showed no major surface damage by the three implants, especially any postulated cartilage damage induced by the heat of the ultrasound-activated pin. The screws protruded above the cartilage surface, which may affect the opposingtibial surface. Conclusion: Using CT scans and scanning electron microscopy, the SonicPin™, the Ethipin® and screws were at least equivalent in refixation quality of osteochondral fragments.
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Affiliation(s)
- Neumann H
- Department of Traumatology, Orthopaedics and Sports Medicine, BG Trauma Centre Hamburg, Germany
| | - Schulz A P
- Department of Biomechatronics and Academic Orthopaedics, University of Schleswig-Holstein, Campus Luebeck, Germany ; Department of Traumatology, Orthopaedics& Reconstructive Surgery, University of Schleswig-Holstein, Campus Luebeck, Germany
| | - Breer S
- Department of Traumatology, Orthopaedics and Sports Medicine, BG Trauma Centre Hamburg, Germany
| | - Unger A
- Department of Biomechatronics and Academic Orthopaedics, University of Schleswig-Holstein, Campus Luebeck, Germany
| | - Kienast B
- Department of Traumatology, Orthopaedics and Sports Medicine, BG Trauma Centre Hamburg, Germany ; Department of Traumatology, Orthopaedics& Reconstructive Surgery, University of Schleswig-Holstein, Campus Luebeck, Germany
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16
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Smith M, Chang CJ. Osteochondritis dissecans of the talar dome in a collegiate swimmer: a case report. J Athl Train 1998; 33:365-71. [PMID: 16558537 PMCID: PMC1320590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To present the case of an intercollegiate swimmer with a stage IV lateral talar dome injury and associated bony fragments. BACKGROUND Lack of distinct diagnostic symptoms, low index of clinical suspicion, and the difficulty of visualizing the early stages of this injury on standard x-rays cause frequent misdiagnosis of talar dome lesions. DIFFERENTIAL DIAGNOSIS Ganglion cyst, with inflammatory synovitis secondary to rupture of cyst; loose bodies from previous occult fracture; osteochondral fracture. TREATMENT Initial treatment with nonsteroidal antiinflammatory drugs and a posterior splint for comfort, followed by arthroscopic excision of loose bodies with abrasion and drilling arthroplasty. UNIQUENESS Patient presented to the team physician for care of acute left medial ankle pain after the athletic trainer had attempted to rupture a ganglion cyst on the anterolateral aspect of the patient's ankle. CONCLUSIONS Increased clinical suspicion is necessary to correctly diagnose osteochondral lesions, particularly in the early stages. Aggressive treatment of talar dome lesions has a good success rate and may be an attractive option for competitive athletes.
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Affiliation(s)
- M Smith
- University of California at Berkeley, Berkeley, CA 94720-4300
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