Osteochondral Fracture Lateral Femoral Condyle Treated with ORIF Using Z-Plasty: A Modification of Coonse and Adams Approach

Sanjay Agarwala,Ganesh S Mohrir,Brijbhushan S Mahajan

doi:10.1155/2011/957196

Abstract

Osteochondral fractures of lateral femoral condyle are common in adolescents and young adults. They are usually caused by direct trauma or twisting injuries of the knee. We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteen-year-old male with a positive history of significant weight gain of 5 kilograms in last six months. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Adequate exposure was achieved by doing Z-plasty of quadriceps apparatus. The fracture was treated with open reduction and internal fixation using Herbert's screws. Medical management in the form of vitamin D and calcium along with testosterone was given. After the surgery, full weight-bearing was allowed at three months. At one year followup, patient has good quadriceps function without any weakness of the muscle.

Highlights

Osteochondral fractures of lateral femoral condyle are common in adolescents and young adults
We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteen-year-old male with a positive history of significant weight gain of 5 kilograms in last six months
Adequate exposure was achieved by doing Z-plasty of quadriceps apparatus

Summary

Case Report

Osteochondral Fracture Lateral Femoral Condyle Treated with ORIF Using Z-Plasty: A Modification of Coonse and Adams Approach. Osteochondral fractures of lateral femoral condyle are common in adolescents and young adults. They are usually caused by direct trauma or twisting injuries of the knee. We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteen-year-old male with a positive history of significant weight gain of 5 kilograms in last six months. To obtain good exposure for anatomical reduction and rigid fixation as well as to get space for use of instrument of definite fixation, Z-plasty of quadriceps apparatus was done (Figure 4, modification of Coonse and Adam’s approach). With Z-plasty, posterior part of lateral femoral condyle was seen clearly (Figure 5(a)) and fracture bed was

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Discussion

Conclusion