Successful hemicondylar femoral allograft for traumatic bone loss: A paediatric case study with ten years of follow-up S. Hornstein, D. Moukoko, F. Deroussen, M.C. Plancq, L.M. Collet, R. Gouron ⁎ Department of Pediatric Orthopedic Surgery, Amiens University Medical Center of Jules Verne University of Picardie, Amiens, France abstract article info Article history: Received 15 May 2014 Received in revised form 10 September 2014 Accepted 28 October 2014 Available online xxxx Keywords: Massive allograft Unicondylar allograft Osteoarticular defect Traumatic bone loss Children The management of massive traumatic defects of the knee joint is challenging, especially in children. Massive osteoarticular allograft may be an option in this kind of traumatic bone loss. We report on the case of a male patient who (at the age of 15) suffered an open grade III condylar femoral joint fracture, with a massive bone defect and a Schatzker V tibial plateau fracture. Ten years after first-line treatment with massive osteoarticular allograft of the lateral femoral condyle, the patient's knee was capable of full extension and 90° flexion. The patient reached a point of being pain free for nine years before he subsequently developed some pain with lateral arthritis progression. © 2014 Elsevier B.V. All rights reserved. 1. Introduction It has been reported that total osteoarticular allografts can success- fully restore function after tumour resections [1]. Osteoarticular allo- grafts are particularly useful in joint reconstruction. Hemicondylar allograft of the distal femur after tumour resection has a high success rate in both adults [2,3] and children [4]. Massive defects of the knee joint can equally be caused by trauma, and reconstruction can also be performed under such circumstances. To the best of our knowledge, there are few publications on massive osteoarticular allografts in the posttraumatic reconstruction of the distal femur [5,6]. Muscolo et al. have reported on the only two cases in children [7] but both allografts were second-line procedures performed about a year after the trauma. Here, we report on the case of a paediatric patient in whom a large osteoarticular defect of the distal femur was treated with a first-line, massive, unicondylar frozen allograft. 2. Case report A 15-year-old boy sustained an open, grade III condylar femoral joint fracture with a massive bone defect and a Schatzker V tibial plateau frac- ture in a motorcycle accident (Fig. 1). He was initially given emergency treatment, with minimal screw osteosynthesis of the tibia and use of an external fixator to bridge the knee joint. The lateral collateral ligament was still inserted distally but had a proximal defect. The posterior cruci- ate ligament (PCL) was intact but the anterior cruciate ligament (ACL) was ruptured. There was no wound defect and soft tissues were easily closed. An electromyogram revealed sciatic neurapraxia. Two weeks later, the patient had no clinical or biological signs of infection and so we performed a reconstruction using a massive frozen osteoarticular allograft of the lateral femoral condyle (Fig. 2). We used a locking bone plate to provide fixation and performed a trans-bone suture of the lateral ligament (Fig. 3). The ACL was not rebuilt. The patient's post- operative course was uneventful. The patient was allowed to place his full weight on the joint (using an articulated splint in full extension) after three months. The splint was removed at nine months after healing had been confirmed radio- graphically (Fig. 4). At two years, neurological recovery was complete. The knee was pain-free and the left leg was two centimeters shorter than the right leg. A clinical examination revealed 90° of flexion (Fig. 5) and full, active extension. The knee displayed grade 2 laxity in the sagittal plane, grade 1 in valgus and a clinical valgus deformity (Fig. 6). However, the patient did not suffer from joint instability when walking unaided so he re- quired neither ACL reconstruction nor a varus osteotomy. A radiograph- ic assessment revealed 9° of valgus, narrowing of the lateral femorotibial joint space and full integration of the graft (i.e. with no ra- diolucency at the bone-graft interface). Ten years after the allograft, the patient reported that his knee was still stable. He wore an orthopaedic insole to compensate for the differ- ence in leg length. The patient walked with a slight limp but did not The Knee xxx (2014) xxx–xxx ⁎ Corresponding author at: Service d'Orthopédie Pédiatrique, CHU d'Amiens, Hôpital Nord, Place Victor Pauchet, F-80054 Amiens Cedex 1, France. Tel.: +33 322 668 365; fax: +33 322 667 764. E-mail address: richard.gouron@gmail.com (R. Gouron). THEKNE-01994; No of Pages 4 http://dx.doi.org/10.1016/j.knee.2014.10.008 0968-0160/© 2014 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect The Knee Please cite this article as: Hornstein S, et al, Successful hemicondylar femoral allograft for traumatic bone loss: A paediatric case study with ten years of follow-up, Knee (2014), http://dx.doi.org/10.1016/j.knee.2014.10.008