Autogenous bone peg fixation for osteochondritis dissecans of the elbow

Abstract

Restoration of pain-free elbow function and prevention of osteoarthritis in patients with osteochondritis dissecans treated with autogenous bone peg fixation. Radiolucent types of osteochondritis and types with zone of demarcation after unsuccessful conservative treatment lasting at least 6 months. Persistence of radiolucent zone or demarcated fragment after previous removal of dissecans fragment. Advanced demarcated fragment almost separated; here early surgery is indicated. Complete separation of dissecans fragment with subchondral sclerosis. Fragmented dissecans fragment. Lateral approach, exposure of capitulum humeri, removal of free bodies if present, drilling of 2.5-mm hole through dissecans fragment and insertion of bone peg harvested from crest of the ulna. Two pegs are used for large fragments. Report of 32 patients (all men, average age 14.8 years, average period of follow-up 5.9 years). Results in 20 patients who underwent a bone peg fixation with or without removal of free bodies were compared to those observed in 12 patients who were either treated conservatively or had only a removal of a free body. The gain in the range of motion, the decrease in pain and the radiologic appearance were superior in the bone peg group.