Biodegradable poly‑L‑lactide‑co‑glycolide copolymer pin fixation of a traumatic patellar osteochondral fragment in an 11‑year‑old child: A novel surgical approach

Sinikumpu,Juha‑Jaakko; Serlo,Willy

doi:10.3892/etm.2016.3934

Biodegradable poly‑L‑lactide‑co‑glycolide copolymer pin fixation of a traumatic patellar osteochondral fragment in an 11‑year‑old child: A novel surgical approach

Authors:
- Juha‑Jaakko Sinikumpu
- Willy Serlo
View Affiliations

Affiliations: Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu, 90029 OYS, Finland
Published online on: November 29, 2016 https://doi.org/10.3892/etm.2016.3934
Pages: 242-246

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Treating displaced patellar bone fractures in growing children remains a challenge for orthopedic surgeons. Removal of loose bone fragments may prolong healing time and result in early onset osteoarthrosis. Therefore, primary fixation of osteochondral fragments is preferred. Metallic pin and screw implants are typically used for fixation, as there is little evidence available regarding the use of modern biodegradable implants in traumatic patellar fractures of a premature skeleton. The present report describes a novel operative technique using headless poly‑L‑lactide‑co‑glycolide (PLGA) pins in treating an 11‑year‑old girl with a patellar fracture from a cycling injury. The surgical technique of this procedure is described in detail in the current report. Excellent subjective outcomes were achieved from this surgery, with superb bone healing according to follow‑up radiographic and computerized tomography scans. In conclusion, the results of this case indicate that, similarly to osteochondritis, intra‑articular osteochondral fractures in children may be fixed using biodegradable PLGA pins. Randomized clinical trials should be performed to confirm this finding and evaluate the use of PLGA pins as a treatment for adolescent osteochondral fractures.

View Figures

View References

1	Nietosvaara Y, Aalto K and Kallio PE: Acute patellar dislocation in children: Incidence and associated osteochondral fractures. J Pediatr Orthop. 14:513–515. 1994. View Article : Google Scholar : PubMed/NCBI
2	Nomura E, Inoue M and Kurimura M: Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy. 19:717–721. 2003. View Article : Google Scholar : PubMed/NCBI
3	Seil R, Weitz FK and Pape D: Surgical-experimental principles of anterior cruciate ligament (ACL) reconstruction with open growth plates. J Exp Orthop. 2:112015. View Article : Google Scholar : PubMed/NCBI
4	Aichroth PM, Patel DV and Zorrilla P: The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. A prospective review. J Bone Joint Surg Br. 84:38–41. 2002. View Article : Google Scholar : PubMed/NCBI
5	Lee BJ, Christino MA, Daniels AH, Hulstyn MJ and Eberson CP: Adolescent patellar osteochondral fracture following patellar dislocation. Knee Surg Sports Traumatol Arthrosc. 21:1856–1861. 2013. View Article : Google Scholar : PubMed/NCBI
6	Gudas R, Kalesinskas RJ, Kimtys V, Stankevicius E, Toliusis V, Bernotavicius G and Smailys A: A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy. 21:1066–1075. 2005. View Article : Google Scholar : PubMed/NCBI
7	Matsusue Y, Nakamura T, Suzuki S and Iwasaki R: Biodegradable pin fixation of osteochondral fragments of the knee. Clin Orthop Relat Res. 166–173. 1996.PubMed/NCBI
8	Din R, Annear P and Scaddan J: Internal fixation of undisplaced lesions of osteochondritis dissecans in the knee. J Bone Joint Surg Br. 88:900–904. 2006. View Article : Google Scholar : PubMed/NCBI
9	Nakagawa T, Kurosawa H, Ikeda H, Nozawa M and Kawakami A: Internal fixation for osteochondritis dissecans of the knee. Knee Surg Sports Traumatol Arthrosc. 13:317–322. 2005. View Article : Google Scholar : PubMed/NCBI
10	Mainil-Varlet P, Rahn B and Gogolewski S: Long-term in vivo degradation and bone reaction to various polylactides. 1. One-year results. Biomaterials. 18:257–266. 1997. View Article : Google Scholar : PubMed/NCBI
11	Rehm KE, Helling HJ and Gatzka C: New developments in the application of resorbable implants. Orthopade. 26:489–497. 1997.(In German). View Article : Google Scholar : PubMed/NCBI
12	Adachi N, Deie M, Nakamae A, Okuhara A, Kamei G and Ochi M: Functional and radiographic outcomes of unstable juvenile osteochondritis dissecans of the knee treated with lesion fixation using bioabsorbable pins. J Pediatr Orthop. 35:82–88. 2015. View Article : Google Scholar : PubMed/NCBI
13	Fraser RK and Cole WG: Osteolysis after biodegradable pin fixation of fractures in children. J Bone Joint Surg Br. 74:929–930. 1992.PubMed/NCBI
14	Böstman O and Pihlajamäki H: Clinical biocompatibility of biodegradable orthopaedic implants for internal fixation: A review. Biomaterials. 21:2615–2621. 2000. View Article : Google Scholar : PubMed/NCBI
15	Rokkanen P, Böstman O, Hirvensalo E, Partio EK, Mäkelä EA, Pätiälä H and Vihtonen K: Bioabsorbable implants in orthopaedics. Curr Orthop. 13:223–228. 1999. View Article : Google Scholar
16	Rokkanen PU, Böstman O, Hirvensalo E, Mäkelä EA, Partio EK, Pätiälä H, Vainionpää SI, Vihtonen K and Törmälä P: Bioabsorbable fixation in orthopaedic surgery and traumatology. Biomaterials. 21:2607–2613. 2000. View Article : Google Scholar : PubMed/NCBI
17	Chotel F, Knorr G, Simian E, Dubrana F and Versier G: French Arthroscopy Society: Knee osteochondral fractures in skeletally immature patients: French multicenter study. Orthop Traumatol Surg Res. 97(8): Suppl. S154–S159. 2011. View Article : Google Scholar : PubMed/NCBI
18	Vähäsarja V, Kinnuen P and Serlo W: Arthroscopy of the acute traumatic knee in children. Prospective study of 138 cases. Acta Orthop Scand. 64:580–582. 1993. View Article : Google Scholar : PubMed/NCBI
19	Vellet AD, Marks PH, Fowler PJ and Munro TG: Occult posttraumatic osteochondral lesions of the knee: Prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology. 178:271–276. 1991. View Article : Google Scholar : PubMed/NCBI
20	Kramer DE and Pace JL: Acute traumatic and sports-related osteochondral injury of the pediatric knee. Orthop Clin North Am. 43:227–236, vi. 2012. View Article : Google Scholar : PubMed/NCBI
21	Schmal H, Strohm PC, Niemeyer P, Reising K, Kuminack K and Sudkamp NP: Fractures of the patella in children and adolescents. Acta Orthop Belg. 76:644–650. 2010.PubMed/NCBI
22	Scopp JM and Mandelbaum BR: Cartilage restoration: Overview of treatment options. J Knee Surg. 17:229–233. 2004.PubMed/NCBI
23	Sgaglione NA, Miniaci A, Gillogly SD and Carter TR: Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee. Arthroscopy. 18(2): Suppl 1. S9–S32. 2002. View Article : Google Scholar
24	Beasley LS and Vidal AF: Traumatic patellar dislocation in children and adolescents: Treatment update and literature review. Curr Opin Pediatr. 16:29–36. 2004. View Article : Google Scholar : PubMed/NCBI
25	Jakob RP, Franz T, Gautier E and Mainil-Varlet P: Autologous osteochondral grafting in the knee: Indication, results, and reflections. Clin Orthop Relat Res. 170–184. 2002. View Article : Google Scholar : PubMed/NCBI
26	Cain EL and Clancy WG: Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med. 20:321–342. 2001. View Article : Google Scholar : PubMed/NCBI
27	Mandelbaum BR, Browne JE, Fu F, Micheli L, Mosely JB Jr, Erggelet C, Minas T and Peterson L: Articular cartilage lesions of the knee. Am J Sports Med. 26:853–861. 1998.PubMed/NCBI
28	Kish G, Módis L and Hangody L: Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Rationale, indications, techniques, and results. Clin Sports Med. 18:45–66, vi. 1999. View Article : Google Scholar : PubMed/NCBI
29	Korhonen J, Sinikumpu JJ, Harmainen S, Ryhänen J, Kallio P and Serlo W: Removal of osteosynthesis material in children and young people. Duodecim. 130:689–695. 2014.(In Finnish). PubMed/NCBI
30	Fuchs M, Vosshenrich R, Dumont C and Stürmer KM: Refixation of osteochondral fragments using absorbable implants. First results of a retrospective study. Chirurg. 74:554–561. 2003.(In German). View Article : Google Scholar : PubMed/NCBI
31	Hirsch G and Boman A: Osteochondral fractures of the knee in children and adolescents treatment with open reduction and osteosynthesis using biodegradable pins. Techniques in Orthopaedics. 13:139–142. 1998. View Article : Google Scholar
32	Sinikumpu JJ, Keränen J, Haltia AM, Serlo W and Merikanto J: A new mini-invasive technique in treating paediatric diaphyseal forearm fractures by bioabsorbable elastic stable intramedullary nailing: A preliminary technical report. Scand J Surg. 102:258–264. 2013. View Article : Google Scholar : PubMed/NCBI