Arthroscopical Fixation of Patellar Osteochondral Fracture in a Pediatric Patient: Case Report

OBJECTIVES: Aim of this article is to present a pediatric patient with patellar osteochondral fracture treated by arthroscopical fixation and discuss through the literature. Patellar osteochondral fractures are kind of injuries mostly seen in adolescents and young adults, generally occur after trauma causing dislocation of patella and frequently accompanied by chondral damage in the lateral femoral condyle. Surgical intervention is indicated for the displaced and intraarticular fragments. METHODS: Thirteen-year-old male patient referred our clinic with a swollen knee, limitation in knee movements, after he had fallen on his right knee while skating 2 weeks previously and was also unable to stand on his right leg. Plain radiogram, computerized tomography and magnetic resonance images of the right knee evaluated in our clinic and a chondral defect (17x10mm in size) in distal of medial marge of patella and an intraarticular osteochondral fragment just inferomedial to patella and anterior to lateral femoral condyle was determined. RESULTS: In the arthroscopical evaluation osteochondral defect and intraarticular fragment were observed. In addition there was chondral lesion on the chondral surface of lateral femoral condyle. Osteochondral fragment was replaced to the distal part of medial marge of patella as arthroscopically, then retrograde fixed using 2 compressive screws (24x2.7 mm and 26x2.7 mm) from patella to the fragment. CONCLUSION: As patellar osteochondral fractures usually occur following acute dislocation of patella, rarely may occur without dislocation. We could find 2 cases in the literature which aren't accompanied by dislocation of patella. One of them is a non-displaced fracture and the other one is an osteochondral fragment with 15x20 mm in size which was resected due to inconformity. Eighty percent of acute dislocations of patella are accompanied by contusions on lateral femoral condyle and intraarticular fragments are present in 11 to 74 percent of cases. In this article we present 13 year-old male patient with an osteochondral fracture in the inferior of medial marge of patella without dislocation of patella, which was displaced into joint space and accompanied by a chondral lesion on the lateral femoral condyle, and then treated by artroscopical reduction and fixation. Our case seems to be original due to occuring without dislocation of patella and being the first case treated by arthroscopical intervention. Displaced and intraarticular patellar osteochondral fractures should be replaced and fixed by surgically. We consider that when compared with open joint surgery, arthroscopical replacement and fixation of osteochondral fractures causes lower morbidity and helps to improve rehabilitation of the patient.