case_images: PMC3505926_01
case_images: Radiographs of knee joint, (a) anteroposterior and (b) lateral.
case_images: CRIM.ORTHOPEDICS2011-957196.001.jpg
case_images: PMC3505926_01_CRIM.ORTHOPEDICS2011-957196.001.jpg
case_images: fig1
case_images: Routine AP and lateral radiographs showed large osteochondral fracture of lateral femoral condyle (Figures 1(a) and 1(b)).
case_images: CT scan with 3D reconstruction.
case_images: CRIM.ORTHOPEDICS2011-957196.002.jpg
case_images: PMC3505926_01_CRIM.ORTHOPEDICS2011-957196.002.jpg
case_images: fig2
case_images: CT scan with 3D reconstruction was done to understand the anatomy of the fracture and to rule out any associated injuries (Figures 2(a), 2(b), 2(c), and 2(d)).
case_images: Photograph showing inadequacy of exposure.
case_images: CRIM.ORTHOPEDICS2011-957196.003.jpg
case_images: PMC3505926_01_CRIM.ORTHOPEDICS2011-957196.003.jpg
case_images: fig3
case_images: There was inadequate exposure with this approach (Figure 3).
case_images: Approach with Z plasty (Modified Coonse and Adams approach).
case_images: CRIM.ORTHOPEDICS2011-957196.004.jpg
case_images: PMC3505926_01_CRIM.ORTHOPEDICS2011-957196.004.jpg
case_images: fig4
case_images: Hence, to obtain good exposure for anatomical reduction and rigid fixation as well as to get space for use of instrument of definite fixation, Z-plasty of quadriceps apparatus was done (Figure 4, modification of Coonse and Adam's approach).
case_images: Exposure before Z-plasty (a) and after Z-plasty (b).
case_images: CRIM.ORTHOPEDICS2011-957196.005.jpg
case_images: PMC3505926_01_CRIM.ORTHOPEDICS2011-957196.005.jpg
case_images: fig5
case_images: With Z-plasty, posterior part of lateral femoral condyle was seen clearly (Figure 5(a)) and fracture bed was nicely visible (Figure 5(b)).
case_images: Temporary k wire fixation.
case_images: CRIM.ORTHOPEDICS2011-957196.006.jpg
case_images: PMC3505926_01_CRIM.ORTHOPEDICS2011-957196.006.jpg
case_images: fig6
case_images: Anatomical reduction of fracture was done and fracture was fixed temporarily with 1.2 mm K-wires (Figure 6).
case_images: Herbert's screw fixation.
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case_images: PMC3505926_01_CRIM.ORTHOPEDICS2011-957196.007.jpg
case_images: fig7
case_images: Definite and stable fixation with Herbert's screws was done (Figure 7) following the AO principles for intra-articular fractures.
case_images: Secure closure of quadriceps.
case_images: CRIM.ORTHOPEDICS2011-957196.008.jpg
case_images: PMC3505926_01_CRIM.ORTHOPEDICS2011-957196.008.jpg
case_images: fig8
case_images: Postfixation quadriceps was securely sutured (Figure 8). 
case_images: Postoperative radiograph.
case_images: CRIM.ORTHOPEDICS2011-957196.009.jpg
case_images: PMC3505926_01_CRIM.ORTHOPEDICS2011-957196.009.jpg
case_images: fig9
case_images: Good anatomic reduction with stable fixation achieved (Figure 9).
case_images: Radiograph at one year follow-up.
case_images: CRIM.ORTHOPEDICS2011-957196.010.jpg
case_images: PMC3505926_01_CRIM.ORTHOPEDICS2011-957196.010.jpg
case_images: fig10
case_images: Radiographs shows good healing without any articular cartilage or subchondral bone changes (Figures 10(a) and 10(b)).