Traumatic isolated osteochondral fractures of medial femoral condyle treated with multiple retrograde Kirschner wires – A simple cost-effective technique

Management of osteochondral fractures of the knee is very crucial to prevent early onset osteoarthritis in young adults. Currently, fixation by biodegradable screws, bioresorbable pins or meniscus arrows can be expensive and also carries risk of complications, such as synovitis and osteonecrosis. In a developing country such as India, there is a need of cost-effective, safe and reproducible treatment option to fix these kinds of fractures. We report the results in 11 patients (seven males and four females) with mean age of 28.09 years, with isolated traumatic osteochondral fracture of medial femoral condyle that was treated between June 2011 and May 2015 with multiple Kirschner wires (K wires). Mean time interval between injury and surgery was 4 days (range, 2–6 days). Through medial parapatellar arthrotomy, the fragment was fixed to its corresponding bed in the medial femoral condyle in a retrograde manner with multiple non-parallel K wires (1.6–2.5 mm). K wires were first drilled through the reduced fragment, the medial femoral condyle and out through the skin on medial side of knee and distal thigh while ensuring through the arthrotomy site that the intra-articular tips of the wires were flush or just buried below the cartilaginous surface of the fragment. Mean time of the union was 8.5 weeks and full range of motion was achieved by 11 weeks. Mean follow-up was 54 weeks (range, 40–64 weeks). Clinical outcomes were found to be excellent in all the patients. Mean IKDC score was 94.9, mean Lysholm score was 94.8 and mean Likert score was 4.63 (range, 4–5) indicating a high level of satisfaction. None of the patients developed any major complications. In third world countries with limited resources, multiple K wires are a safe, reproducible and relatively inexpensive method of treating these complex joint injuries in young adults.