The surgical treatment of osteochondritis of the capitellum

Abstract

This paper reviews 14 patients who underwent elbow arthrotomy for osteochondritis of the capitellum. The etiology in 7 of the 14 cases appears to be the result of repeated trauma from throwing sports. Five of the 14 described a singular significant traumatic episode, and in 2 of the 14, a clear etiology is uncertain. The diagnostic features including signs, symptoms, and el bow range of motion are examined. The operative findings are correlated with plain x-ray films of the elbow in all cases and with an elbow arthrogram in 11 out of 14 cases. The average length of followup was 24 months. The postoperative range of motion was in creased an average of 18°. Eighty-six percent (12 out of 14) patients returned to organized, competitive ath letic activity without restrictions.

The Little League background of those patients with apparent repetitive microtrauma to the elbow is exam ined in terms of length of pitching experience and types of pitches thrown. In addition, the throwing mechanism of these patients is evaluated with respect to the type of delivery at possible risk for the development of osteochondritis.

We conclude that after a failure of conservative ther apy, surgical treatment, including removal of the intraar ticular loose bodies, excision of capitellar lesions, and curettage to bleeding bone can be expected to produce pain relief and improvement in joint motion. A return to organized competitive sport activities can be expected.

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References

Adams JE Injury to the throwing arm: A study of traumatic changes in the elbow joints of boy baseball players Calif Med 102: 127-132, 1965

Adams JE Bone injuries in very young athletes Clin Orthop 58 129-140, 1968

Albright JA, Jokl P., Shaw R., et al Clinical study of baseball pitchers Correlation of injury to the throwing arm with method of delivery Am J Sports Med 6. 15-21, 1978

Barnes DA, Tullos HS An analysis of 100 symptomatic baseball players Am J Sports Med 6 62-67, 1978

Bennett GE: Shoulder and elbow lesions distinctive of baseball players. Ann Surg 126. 107-110, 1947

Bennett GE Elbow and shoulder lesions of baseball players Am J Surg 98 484-492, 1959

Bennett GE Shoulder and elbow lesions of the professional baseball pitcher. JAMA 117. 510-514, 1941

Brogdon BG, Crow NE Little Leaguer's elbow Am J Roentgenol 83: 671-675, 1960

Brown R., Blazina ME, Kerlan RK, et al: Osteochondntis of the capitellum J Sports Med 2 27-46, 1974

10.

Francis R., Bunch T., Chandler B. Little League elbow: A decade later Physician Sportsmed 6 88-94, 1978

11.

Green WT, Banks HH Osteochondritis dissecans in children J Bone Joint Surg 35A: 26-47, 1953

12.

Gugenheim JJ Jr, Stanley RF, Woods GW, et al: Little League survey: The Houston study Am J Sports Med 4. 189-200, 1976

13.

King D.: Osteochondritis dissecans: A clinical study of twenty-four cases. J Bone Joint Surg 14: 535, 1932

14.

King JW, Brelsford HJ, Tullos HS Analysis of the pitching arm of the professional baseball pitcher Clin Orthop 67. 116-123, 1969

15.

King JW, Brelsford HJ, Tullos HS: Epicondylitis and osteochondritis of the professional baseball pitcher's elbow AAOS: Symposium on Sports Medicine, 75-86

16.

Kolliker A.: Human histology. Vol I, New Syd Soc, London, 1853 p 329

17.

Konig F. Lehrbuch der allgemeinen chirugic fur aerzte and studirende. Berlin A Hirschwald, 1889, p. 751

18.

Larson RL, McMahan RO: The epiphyses and the childhood athlete JAMA 196 99-104,1966

19.

Larson RL, Singer KM, Bergstrom R., et al: Little League survey: The Eugene study Am J Sports Med 4 201-209, 1976

20.

Lipscomb AB Baseball pitching injuries in growing athletes J Sports Med 3. 25-34, 1975

21.

Micheli LJ Sports injuries in children and adolescents. In Sports Medicine and Physiology, Philadelphia, WB Saunders, 1979, pp 288-303

22.

Middiman IC Shoulder and elbow lesions of baseball players . Am J Surg 102: 627-632, 1961

23.

Monro A.: Part of the cartilage of the joint of the knee separated and ossified . Medical Essary and Observations, IV, 305, 1738

24.

Nagura S. The so-called osteochondritis dissecans of Konig Clin Orthop 18: 110-119, 1960

25.

Paget J. On the production of some of the loose bodies in joints St Bartholomeu's Hospital Reports 6 1-4, 1870

26.

Panner HJ An affection of the capitellum humen, resembling Calve-Perthes disease of the hip Acta Radiologica 10. 234, 1927

27.

Paré A. Oeuvres completes Pans, JB Balliere, Tome III, 1840-1841, p 32

28.

Rainey J. (Discussion) Trans Path Soc, Vol II, 110, 1848-50

29.

Roberts N., Hughes R. Osteochondritis dissecans of the elbow joint: A clinical study J Bone Joint Surg 32B: 348-360, 1950

30.

Slager RF From Little League to big league, the weak spot is the arm. Am J Sports Med 5 37-48, 1977

31.

Slocum DB Classification of elbow injuries from baseball pitching Tex Med 64 48-53, 1968

32.

Smith Mgh Osteochondritis of the humeral capitellum J Bone Joint Surg 46B 50-54, 1964

33.

Stougaard J. Familial occurence of osteochondritis dissecans J Bone Joint Surg 46B 542-543, 1964

34.

Tivnon MC, Anzel SH, Waugh TR Surgical management of osteochondritis dissecans of the capitellum Am J Sports Med 4 121-128, 1976

35.

Torg JS Little League "The theft of a carefree youth " Physician Sportsmed 1 72-78, 1973

36.

Torg JS, Pollack H., Sweterlitsch P. The effect of competitive pitching on the shoulders and elbows of pre-adolescent baseball players Pediatrics 49 267-272, 1972

37.

Tnas A., Ray RD Juvenile osteochondritis of the radial head—report of a bilateral case J Bone Joint Surg 45A 576-582, 1963

38.

Tullos HS, King JW Lesions of the pitching arm in adolescents. JAMA 220 264-271, 1972

39.

Tullos HS, King JW: Throwing mechanism in sports. Orthop Clin North Am 4 709-720, 1973

40.

Tullos HS, Erwin WD, Woods GW, et al: Unusual lesions of the pitching arm Clin Orthop 88 169-182, 1972

41.

Wagoner G., Cohen Bwe Osteochondritis dissecans A resume of the theones of etiology and the consideration of hereditary as an etiologic factor Arch Surg 23 1-24, 1931

42.

Woodward AH , Bianco AJ Osteochondritis dissecans of the elbow. Clin Orthop 110 35-41, 1975