Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature

A 17-year old soccer-player sustained a fracture and dislocation of the ulnar epicondyle combined with a bone bruises at the radial head and the capitellum. An open reduction and internal fixation was performed using two K-wires. Initial recovery was uneventful. After the operation he was discharged home and reviewed on a regular basis. When bony union had occurred the two K-wires were removed. However, on follow up he continued to complain of pain on the radial aspect of the joint and did not regain his normal range of movement. A further MRI was performed. Now a grade II osteochondritis dissecans not visible on the previous MRI taken 12 weeks earlier was clearly visualised. Treatment was continued conservatively with physiotherapy but avoiding aggressive mobilisation. On final review 6 months later he was able to move painfree with residual limitation of movement (ROM 0–5–130°). Another MRI taken now was assessed as normal.This study was carried out at the Dept of MRI, Klinik für Radiologische Diagnostik, Klinikum Saarbrücken, Winterberg 1, D- 66119 Saarbrücken.     

Navigated versus conventional drilling of the knee in a model of obesity

Core decompression by exact drilling into ischemic lesions of the femoral condyle stays a challenging procedure, particularly in obese patients. The precision of fluoroscopically-based drilling compared to conventional drilling was evaluated in an in-vitro model for obesity. 40 sawbones were prepared mimicking osteonecrosis in obese patients. 20 sawbones were drilled by guidance of an intraoperative navigation system VectorVision® (BrainLAB, Munich, Germany); the other 20 sawbones were conventionally drilled by fluoroscopic control only. Regarding the distance to the desired mid-point of the lesion, a statistically significant difference with 0.55 mm in the navigated group and 1.19 mm in the control group could be stated (p<0.001). Significant differences were further found for the number of drilling corrections (p<0.001) and radiation time needed (p<0.001). Even in difficult circumstances as in obese patients, the drilling guided by the VectorVision®-navigation system shows high precision with simultaneous enormous reduction of radiation time.     

Longitudinal long-term results of surgical treatment in patients with osteochondritis dissecans of the femoral condyles

In a longitudinal study, we performed a second follow-up examination on patients suffering from osteochondritis dissecans at the femoral condyles 10 years after a first follow-up, which had been performed 10 years after surgical treatment. Results (clinical score; radiological signs of OA) were analysed depending on the stage of the epiphyseal plate at the time of surgery, the used surgical procedure was divided into retrograde and anterograde procedures, and removal of loose bodies depending on the stage of the lesion. The analysis clearly exhibited that JOCD patients demonstrated better results than AOCD patients. The clinical score obtained after 10 years improved significantly with time, particularly for JOCD patients. Overall, when a retrograde procedure had been used in cases with an intact cartilage layer clinical results were better than those obtained in patients in whom an anterograde procedure with restoration of the joint surface or simple removal of the loose fragments had been performed. After a mean follow-up of 20 years the mean OA-stage was 0.27 in JOCD patients, whereas in AOCD patients a mean OA-stage of 1.55 was detected. Worst OA-changes were detected in patients in whom acrylic glue had been used for refixation of the loose bodies. Mark Rayf and Joern Steinhagen are Doctoral students.     

The ultrastructure of osteochondrosis of the articular-epiphyseal cartilage complex in growing swine

Summary Osteochondrosis of the articular-epiphyseal cartilage complex (A-E complex) is a significant clinical disease in swine. It has been suggested that osteochondrosis is the underlying cause of osteochondritis dissecans in humans. The purpose of this investigation was to characterize the ultrastructural changes in the earliest macroscopically visible lesion of the epiphyseal cartilage in osteochondrosis of the A-E complex in swine. Osteochondritic epiphyseal cartilage from the distal femora and humeri of growing crossbred boars was collected, embedded in plastic, and studied light and electron microscopically. The predominant lesion was chondronecrosis, characterized by chondrocyte death and loss of matrical proteoglycan. Transition from normal to abnormal cartilage was abrupt. Lipid accumulated in chondrocytes within and adjacent to lesions, but not in chondrocytes distant from lesions. Intracellular lipid accumulation was an important feature of the lesion and may play a role in its initiation. It is hypothesized that intracellular lipid accumulation results from hypoxia/anoxia and may precede matrix degeneration, which precedes cell death.     

Acute chondrolysis complicating Legg-Calvé-Perthes disease

Of 270 children with Legg-Calvé-Perthes (LCP) disease, roentgenographic evidence of chondrolysis was noted in 12 (4.5%) within one year after diagnosis and appropriate management. Only in six hips of these 12 patients did the retrospective clinical, histological, and orthopedic findings fulfill the diagnostic requirements for chondrolysis. Sequential roentgenographic findings included initial periarticular osteoprosis and subchondral cortical irregulatities, subsequent narrowing of the joint space, premature fusion of the growth plate, and eventual development of degenerative arthritis. The early roentgenographic recognition of chondrolysis is emphasized because it has an untoward effect on the prognosis of LCP and should there-fore prompt a different orthopedic approach.     

Osteochondritis dissecans of the patellofemoral groove in athletes: unusual cases of patellofemoral pain

Five athletes who developed osteochondritis dissecans in the patellofemoral groove in the course of sports events at high school and college league level are described. They were male athletes complaining of anterior knee pain. When examining young people engaged in violent sports, it is well to remember that they might have osteochondritis dissecans in the patellofemoral groove. Clinically, four of the five patients under discussion were characterized by tight movements of the patella in a direction parallel to its transversal axis. X-ray studies in lateral projections and CT scans provided useful tools for definitive diagnosis, but AP radiography was no help in diagnosis. Release of a tight lateral retinaculum with or without drilling on the degenerated cartilage was effective in the treatment of osteochondritis dissecans of the patellofemoral groove in three of the four patients.     

双腕掌关节脱位一例

×× ,女 ,19岁 ,学生。 2小时前患者骑自行车行驶中 ,被横向坠落的木棒击中双侧手背、前臂。双侧手背肿胀 ,呈银叉样畸形 ,压痛明显 ,手指伸屈功能障碍。Ｘ线片显示双侧肱骨、桡骨骨折外 ,双侧掌骨基底部向背侧移位 ,并和远排腕骨相重叠。双侧肱骨、桡骨给予相应处理 ,双侧腕掌关节脱位行闭合复位 ,配合中药薰洗及功能锻炼。术后 1个月随诊 ,双手指伸屈功能较差 ,2个月后双手功能恢复良好。讨论　双腕掌关节同时脱位临床罕见 ,因为掌骨基底间、腕骨间及掌骨和腕骨间均有坚强的韧带相连 ,且腕掌关节的活动范围极小 ,坚固稳定 ,因此很难脱位…     

Idiopathic osteonecrosis of the first metatarsal sesamoid

Four patients with histologically confirmed osteonecrosis of the first metatarsal sesamoid are presented. No patient was an athlete, nor recalled any noticeable trauma or significant stress as having occurred to the feet. No foot deformities or joint malalignments were found. Excellent results were obtained by excision of the affected sesamoid in all patients, after follow-up periods of 1 to 12 years. Microscopic findings were compatible with those seen in idiopathic osteonecrosis of the femoral head.