[Autogenous bone peg fixation for osteochondritis dissecans of the elbow]

Abstract

Objectives: Restoration of pain-free elbow function and prevention of osteoarthritis in patients with osteochondritis dissecans treated with autogenous bone peg fixation.

Indications: 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.

Contraindications: Complete separation of dissecans fragment with subchondral sclerosis. Fragmented dissecans fragment.

Surgical technique: 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.

Results: 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.

Keywords: Bone peg procedure; Osteochondritis dissecans.