Osteochondral fractures occur infrequently in children and adolescents. If they do occur, they occur most often in adolescent boys and are usually fracture fragments from the femoral condyles or the patella. The mechanism of injury is a direct blow to the knee, flexion-rotation of the knee, or patellar dislocation. The history is typically one of an acute injury with a pop or snap, causing severe pain and an acute effusion. The fracture is difficult to see on radiographs, so careful attention should be paid to the femoral condyles as well as to the patella. Treatment is surgical removal of the fracture fragment or surgical fixation of the fragment. Prognosis is good for small fragments not involving the weight-bearing surface of the joint. Prognosis is less favorable for larger fragments involving the weight-bearing surface.28
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