Open Reduction and Internal Fixation of an Osteochondral Patellar Fracture in an Eleven Year-Old Girl

Abstract

WOsteochondral patellar fractures in pediatric age can result from acute patellar dislocations (APDs). The purpose of this article is to document and discuss the surgical treatment performed to a young female patient diagnosed with an osteochondral fracture (OCF) of the patella in the first episode of an APD. We state the first episode of an APD in a 12 year-old girl, who presented with pain, edema and limited extension of the right knee, after a direct knee trauma. She had no predisposing factors regarding patellofemoral instability. This patient was treated at our Orthopaedic Surgery Department and then clinically (Kujala score) and radiographically evaluated, at 12 months of follow-up. The knee radiograms gave rise to the suspicion of a large inferior osteochondral patellar fragment. Operative treatment was decided and open reduction and internal fixation (ORIF) of the fragment was performed, through a medial parapatellar approach. The fragment dimensions were 24x18mm. The medial structures were addressed and repaired. The patient went through a rehabilitation programme and returned to full activities three months postoperatively. After 12 months of follow-up, there was full range of motion, no redislocation episodes and the Kujala score was 96. Open reduction and anatomic in situ internal fixation of the osteochondral fragment was mandatory in this case, due to its dimensions and location. We consider this a safe and efficient technique that allows osteosynthesis of the osteochondral fragment; the approach used makes possible the acute repair of the medial structures. There is still no general consensus about whether or not to reconstruct the medial patellofemoral ligament (MPFL) in the context of a primary APD. WOsteochondral patellar fractures in pediatric age can result from acute patellar dislocations (APDs). The purpose of this article is to document and discuss the surgical treatment performed to a young female patient diagnosed with an osteochondral fracture (OCF) of the patella in the first episode of an APD. We state the first episode of an APD in a 12 year-old girl, who presented with pain, edema and limited extension of the right knee, after a direct knee trauma. She had no predisposing factors regarding patellofemoral instability. This patient was treated at our Orthopaedic Surgery Department and then clinically (Kujala score) and radiographically evaluated, at 12 months of follow-up. The knee radiograms gave rise to the suspicion of a large inferior osteochondral patellar fragment. Operative treatment was decided and open reduction and internal fixation (ORIF) of the fragment was performed, through a medial parapatellar approach. The fragment dimensions were 24x18mm. The medial structures were addressed and repaired. The patient went through a rehabilitation programme and returned to full activities three months postoperatively. After 12 months of follow-up, there was full range of motion, no redislocation episodes and the Kujala score was 96. Open reduction and anatomic in situ internal fixation of the osteochondral fragment was mandatory in this case, due to its dimensions and location. We consider this a safe and efficient technique that allows osteosynthesis of the osteochondral fragment; the approach used makes possible the acute repair of the medial structures. There is still no general consensus about whether or not to reconstruct the medial patellofemoral ligament (MPFL) in the context of a primary APD.