The Journal of Bone and Joint Surgery (American). 2008;90:1473-1478.
doi:10.2106/JBJS.G.00595
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Large Osteochondral Fractures of the Lateral Femoral Condyle in the Adolescent: Outcome of Bioabsorbable Pin Fixation

Stewart J. Walsh, MD1, Matthew J. Boyle, MD1 and Vicki Morganti, MD2

1 Department of Orthopaedic Surgery, Starship Children's Hospital, Private Bag 92024, Auckland 1142, New Zealand. E-mail address for S.J. Walsh: stewartw{at}adhb.govt.nz
2 Department of Radiology, Auckland City Hospital, Private Bag 92024, Auckland 1142, New Zealand

Investigation performed at the Department of Orthopaedic Surgery, Starship Children's Hospital, Auckland, and the Department of Radiology, Auckland City Hospital, Auckland, New Zealand

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Wishbone Trust, New Zealand. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Large osteochondral fractures of the lateral femoral condyle of the knee in adolescent patients can be diagnostically and therapeutically challenging. Historically, management has involved removal of the fragment, leaving a large area of bone devoid of articular cartilage on the weight-bearing surface of the lateral femoral condyle. This study assessed open reduction and internal fixation of the osteochondral fragments with use of multiple polyglycolic acid rods.

Methods: Eight patients, between twelve and fifteen years old, with a large (>4 cm2) osteochondral fracture of the lateral femoral condyle were treated with open reduction and internal fixation with use of multiple polyglycolic acid rods. Each patient was evaluated at more than five years (a mean of nine years) after the index procedure with a clinical assessment, during which the knee was scored according to the International Knee Documentation Committee and Cincinnati knee rating systems, plain radiographs were made, and magnetic resonance imaging scans were acquired.

Results: The majority of patients scored well on both knee rating systems, with no poor results. Five of the eight patients had normal findings on knee radiographs, and three had radiographs that showed minor changes. Magnetic resonance imaging scans of all cpatients demonstrated intact articular cartilage in the lateral compartment with no area of full-thickness articular cartilage loss. No evidence of articular cartilage thinning was seen in two knees; a small area of <2 cm2 of cartilage thinning, in four; a moderate area of 2.7 cm2 of cartilage thinning, in one; and a large area of 11.2 cm2 of abnormal cartilage signal, in one knee.

Conclusions: Osteochondral fracture of the lateral femoral condyle is an injury to which adolescents with ligamentous laxity of the knee are prone. Our results show that internal fixation of these osteochondral fragments with bioabsorbable implants is possible and is a worthwhile option.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

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Fixation of osteochondral fractures of the lateral femoral condyle in the adolescent
A. Ludwig Meiss, et al.
JBJS Online, 4 Aug 2008 [Full text]
Dr. Walsh and colleagues respond to Drs. Meiss and Placzek
Stewart J Walsh, et al.
JBJS Online, 15 Sep 2008 [Full text]