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Letters to the Editor to:

Scientific Articles:
Stewart J. Walsh, Matthew J. Boyle, and Vicki Morganti
Large Osteochondral Fractures of the Lateral Femoral Condyle in the Adolescent: Outcome of Bioabsorbable Pin Fixation
J Bone Joint Surg Am 2008; 90: 1473-1478 [Abstract] [Full text] [PDF]
*Letters to the Editor: Submit a response to this article

Electronic letters published:

[Read Letter to the Editor] Dr. Walsh and colleagues respond to Drs. Meiss and Placzek
Stewart J Walsh, Matthew J Boyle   (15 September 2008)
[Read Letter to the Editor] Fixation of osteochondral fractures of the lateral femoral condyle in the adolescent
A. Ludwig Meiss, Richard Placzek   (4 August 2008)

Dr. Walsh and colleagues respond to Drs. Meiss and Placzek 15 September 2008
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Stewart J Walsh,
Orthopaedic Surgeon
Starship Children's Hospital, Auckland, New Zealand,
Matthew J Boyle

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Re: Dr. Walsh and colleagues respond to Drs. Meiss and Placzek

stewartw{at}adhb.govt.nz Stewart J Walsh, et al.

We were interested to read the comments provided by Drs. Meiss and Placzek in response to our article(1) and we thank them for their letter. We also appreciate their drawing our attention to their abstract, outlining the management of a large osteochondral lesion involving the posterior weight-bearing surface of the lateral femoral condyle in an eleven year old boy(2).

The diagnosis in this case was delayed by approximately one year and the management involved bone grafting in addition to repair of the osteochondral lesion with absorbable sutures. Although this case was not published at the time that our article was submitted for publication, it raises two important points. Firstly, the case demonstrates that healing of large traumatic osteochondral lesions of the lateral femoral condyle in the adolescent is possible and repair should therefore be considered. Second, the need for a high degree of clinical suspicion is highlighted as a diagnostic delay in this patient may have led to the development of subchondral bony irregularities and alteration in the size and shape of the chondral fragment making reduction more difficult.

We suspect that these traumatic injuries to the lateral femoral condyle occur more frequently than has previously been appreciated. The method of fixation that Dr Meiss and Dr Placzek describe is another option for surgeons encountering this problem.

References

1. Walsh SJ, Boyle MJ, Morganti V. Large osteochondral fractures of the lateral femoral condyle in the adolescent. Outcome of bioabsorbable pin fixation. J Bone Joint Surg Am. 2008;90:1473-1478.

2. Meiss AL, Placzek R. Cystic lesions in the lateral femoral condyle of an 11-year-old boy – of tumorous, parasitic or traumatic origin? 4 ˝ year follow-up. J Child Orthop. 2008;2:160-162.
Fixation of osteochondral fractures of the lateral femoral condyle in the adolescent 4 August 2008
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A. Ludwig Meiss,
Pediatric Orthopaedic Surgeon
University Hospital Hamburg-Eppendorf, Germany,
Richard Placzek

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Re: Fixation of osteochondral fractures of the lateral femoral condyle in the adolescent

meiss{at}uke.uni-hamburg.de A. Ludwig Meiss, et al.

To the Editor:

Dr. Walsh and colleagues describe successful internal fixation of osteochondral fragments of the lateral femoral condyle with bioabsorbable pins (1). We believe that fixation by absorbable sutures can also be an option.

In this context we would like to draw the authors' attention to the successful resuturing of a large osteocartilagenous flake involving the posterior weight-bearing portion of the lateral femoral condyle in an 11- year-old boy (2). There was a delay of diagnosis of about a year. A posterior and anterior approach was necessary to allow placement of the sutures (with 5-0 Vicryl). In addition a debridement of the site of reimplantation was performed followed by cancellous bone transplantation. This may have favored the healing of the fragment to the underlying bone.

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. 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.

References:

1. Walsh StJ, Boyle MJ, Morganti V. Large osteochondral fractures of the lateral femoral condyle in the adolescent: outcome of bioabsorbable pin fixation. J Bone Joint Surg Am. 2008;90:1473-1478.

2. Meiss AL, Placzek R. Cystic lesions in the lateral femoral condyle of an 11-year-old boy - of tumorous, parasitic or traumatic origin? 4 1/2 year follow-up. J Child Orthop. 2008;2:160-162