Large osteochondral fragments can be reattached with cannulated headless screws.
As headless screws are not resorbable, it is important that the ends of the screws are below the cartilage. The bony part of the fragment must therefore be large enough to accommodate the proximal thread of the headless screw.
Note: The osteochondral fragment can become necrotic, leading to prominence of the screw end. This is suggested by pain during movement, and mandates screw removal.
At least two divergent screws should be used to provide satisfactory fixation and some axial compression.
Forces through the hip are less with toe-touch weight bearing than with no weight bearing. Therefore, toe-touch is normally recommended for initial mobilization. This needs to be taught to children by a physiotherapist.
Range of movement
Range-of-movement exercises should start in the immediate postoperative period to prevent stiffness. Surgeons should indicate if any extremes of movement are forbidden.
Having started with toe-touch weight bearing, children progress to partial weight bearing and then to full weight bearing according to their age and the predicted rate of healing of their fracture. Even older adolescents should be fully weight bearing without aids at three months.
Swimming can be allowed as soon as partial weight bearing is permitted. Contact sports should be avoided for at least six months.
X-rays are generally taken immediately after the surgery and at 6 and 12 weeks.
Implants that cross the physis should be removed if there is significant growth remaining. The fracture should be healed and consolidated prior to removal (see Healing times).
Implants in young children should always be removed to prevent them from being covered by bony overgrowth.