Detaillierte Beitrags-Information
| Beitragstitel | Preservation of the osteochondral fragment in osteochondritis dissecans of the capitellum humeri |
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| Beitragscode | P24 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
Background Osteochondritis dissecans (OD) of the capitellum humeri is the third localization in frequency after OD of the knee and the talus. Untreated lesions can lead to early osteoarthritis of the involved joint. Stable lesions regularly are treated non-operatively by immobilization of the joint. Unstable small lesions are most frequently treated by arthroscopic debridement and microfractures. Unstable larger lesions can be treated either by autologous osteochondral transplantation from the knee or the rib, or closing wedge osteotomy. Only few reports deal with surgical refixation of large osteochondral fragments. Method We report two cases of successful refixation of relatively large OD fragment of the capitellum humeri. Both, a 28-year-old man and a 16-year-old boy, respectively suffered from a symptomatic OD of the elbow. In both cases the joint was exposed through a small Kocher approach. Then, the bed of the OD fragment was debrided, the remaining defect filled of using autologous bone taken from the olecranon, and the fragment stabilized either by resorbable sutures (case 1) or with 3 HCS 1.5 mm screws (case 2). Case Age (years) Size of OD (mm) Fixation Follow up (months) 1 28 4 x 5 Suture 12 2 16 15 x 15 1.5mm HCS screws 20 Postoperatively, early mobilization in supination without axial load for 6 weeks was allowed in both cases. Results Healing of the OD fragment was undisturbed and without secondary displacement in both patients. The clinical functional score was excellent for both cases (46 of 48 points with the Oxford Elbow Score). Conclusion Preservation of even large osteochondral fragments in OD of the elbow is possible. Key for success are the careful debridement of scar tissue in the OD bed, autologous bone grafting of the defect, and stable fixation of the osteochondral fragment by suture or small screws. Functional rehabilitation is possible preventing joint stiffness and having a positive effect on the nutrition of the cartilage. |