Osteochondral Fractures
Discussion points- Describe the most frequent sites of osteocondral fracture in the child
- Describe the repair process for osteochondral fractures
- Describe present treatment approaches for osteochondral fractures
Discussion
The most frequent site of osteochondral fractures in children is the knee. Osteochondral lesions are also relatively common in the talus, whether these result from acute fractures is still uncertain. A study of acute hemarthrosis in children revealed osteochondral fractures were found in 67% as a result of acute patellar dislocation. Our knowledge of healing of osteochondral fractures is incomplete. Children have more potential to heal osteochondral fractures than adults. After an osteochondral fracture, the defect fills with a fibrin clot. Injury to bone releases multiple growth factors. The release and role of growth factors secondary to cartilage injury is not well defined at present. Mesenchymal cells migrate into the clot, and within 2 weeks produce a matrix that contains type II collagen, proteoglycans, and some type I collagen. The defect ultimately heals with a substantial fibrous component, intermediate between hyaline cartilage and fibrocartilage. The repair cartilage does not bond firmly to the surrounding intact cartilage. With time, the hyaline like component of the repair cartilage disappears, and the there is a fibroblast like appearance of the remaining cells. Whether the repair process is the same for osteochondritis dissecans is not certain. There have been attempts at autogenous grafting of osteochondral defects; but in general this is an area waiting for development. Most osteochondral fractures are now treated merely by excision of the fragment. Operative attempts to replace fragments have been reported, with either threaded Steinman pins or Herbert screws. It is conjectural at present whether these methods produce results superior to excision.
References
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May 16-19, 2012 in Denver, CO
