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Knee osteochondral fractures in skeletally immature patients: French multicenter study.
[trochlear dysplasia]
Femoral
or
patellar
osteochondral
fractures
complicating
patellar
dislocation
are
more
frequently
observed
in
adolescents
than
in
adults
.
These
incidental
lesions
of
vulnerable
joint
cartilage
are
often
neglected
in
the
initial
phase
,
which
is
regrettable
given
their
good
capacity
for
healing
after
repositioning
.
The
objective
of
this
study
was
to
investigate
the
characteristics
and
analyze
the
results
of
repositioning
these
fractures
in
skeletally
immature
patients
.
This
retrospective
multicenter
study
grouped
14
patients
and
knees
(
seven
females
)
.
The
mean
age
at
the
time
of
the
accident
was
12
.
9
years
(
range
,
11
.
2
-
14
.
9
years
)
for
the
girls
and
14
years
(
range
,
12
.
2
-
15
years
)
for
the
boys
.
These
fractures
involved
the
lateral
condyle
in
nine
cases
and
the
patella
in
five
cases
.
The
injury
mechanism
was
secondary
to
demonstrated
patellar
dislocation
(
n
=
9
)
or
a
direct
impact
(
n
=
4
)
.
In
nine
cases
out
of
14
,
a
leisure
sports
accident
was
the
cause
.
The
injury
was
treated
a
mean
5
.
2
days
(
range
,
0
-
20
days
)
after
the
accident
.
All
of
the
detached
fragments
were
repositioned
surgically
with
screw
fixation
(
n
=
5
)
,
resorbable
pins
(
n
=
5
)
,
or
pull-out
suture
(
n
=
4
)
.
Biological
glue
was
added
for
six
patients
.
Patellar
stabilization
was
associated
during
the
same
procedure
in
two
cases
.
No
postoperative
complications
were
observed
.
The
results
at
the
mean
follow-up
of
30
months
(
range
,
15
-
89
months
)
showed
no
revision
for
failure
,
with
all
of
the
fractures
demonstrating
union
at
the
final
examination
.
The
mean
IKDC
2000
subjective
score
was
88
±
6
(
range
,
79
-
98
)
out
of
100
points
.
The
subjective
satisfaction
level
was
very
satisfied
in
two
cases
and
satisfied
in
the
12
others
.
The
final
IKDC
score
was
A
for
eight
patients
,
B
for
five
patients
,
and
C
for
one
patient
.
Three
patients
underwent
secondary
patellar
stabilization
surgery
.
Better
knowledge
of
this
fracture
and
attentive
reading
of
the
radiographic
images
of
a
knee
with
hemarthrosis
should
result
in
more
frequent
diagnosis
of
this
condition
and
adapted
treatment
.
Unexplained
hemarthrosis
in
a
context
of
trochlear
dysplasia
should
be
considered
to
be
associated
with
an
OCF
until
proof
of
the
contrary
.
A
fragment
released
in
a
weightbearing
zone
should
ideally
be
repositioned
within
10
days
but
remains
possible
at
2
months
.
It
regularly
provides
bone
union
and
good
results
in
children
.
Diseases
Validation
Diseases presenting
"skeletally immature patients"
symptom
trochlear dysplasia
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