Osteochondral fracture - patella

Case contributed by Jeremy Jones

Presentation

Crunching tackle while playing football. Swollen knee. Can't weight-bear.

Patient Data

Age: 14 years
Gender: Male
x_ray

Huge bony fracture fragment adjacent to the lateral femoral condyle. Further smaller bony fragment superiorly within a large effusion. The donor site is not clear, but given very normal looking femoral condyles, patella is suspected.

CT confirms a large patellar defect corresponding to the large fracture fragment. There are additional smaller fragments of bone within the joint and a moderate sized fragment in the suprapatallar pouch.

x_ray

Post-operative film after the orthopod had reduced and fixed the patellar fracture and washed out the knee.

Case Discussion

It is important to ascertain where the donor site is in this type of case so that the surgeon can plan their approach.

This operation required a midline incision down onto patella with opening of the knee so that the surgeon could access the undersurface of the patella. It is also helpful to let them know about any other fragments that might not be visible operatively such as the moderate sizes fragment in the suprapatellar pouch.

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