PMC3505926_01
Radiographs of knee joint, (a) anteroposterior and (b) lateral.
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fig1
Routine AP and lateral radiographs showed large osteochondral fracture of lateral femoral condyle (Figures 1(a) and 1(b)).
CT scan with 3D reconstruction.
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fig2
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)).
Photograph showing inadequacy of exposure.
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fig3
There was inadequate exposure with this approach (Figure 3).
Approach with Z plasty (Modified Coonse and Adams approach).
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fig4
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).
Exposure before Z-plasty (a) and after Z-plasty (b).
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fig5
With Z-plasty, posterior part of lateral femoral condyle was seen clearly (Figure 5(a)) and fracture bed was nicely visible (Figure 5(b)).
Temporary k wire fixation.
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fig6
Anatomical reduction of fracture was done and fracture was fixed temporarily with 1.2 mm K-wires (Figure 6).
Herbert's screw fixation.
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fig7
Definite and stable fixation with Herbert's screws was done (Figure 7) following the AO principles for intra-articular fractures.
Secure closure of quadriceps.
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fig8
Postfixation quadriceps was securely sutured (Figure 8). 
Postoperative radiograph.
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fig9
Good anatomic reduction with stable fixation achieved (Figure 9).
Radiograph at one year follow-up.
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fig10
Radiographs shows good healing without any articular cartilage or subchondral bone changes (Figures 10(a) and 10(b)).