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Age: 21

Sex: Male

Indication: Elbow pain

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Case #4


Findings

  • No acute fracture or malalignment
  • Osteochondral lesion of the capitellum measuring 10 x 6 mm
  • Remote ununited avulsion fracture at the site of humeral attachment of the ulnar collateral ligament


Diagnosis

  • Osteochondral lesion of the capitellum

Sample Report

No acute fracture or malalignment.

No elbow joint effusion.

Osteochondral lesion of the capitellum measuring 10 x 6 mm. No evidence of intraarticular body. Consider MRI to assess for signs of instability.

Remote ununited avulsion fracture at the site of humeral attachment of the ulnar collateral ligament.


Discussion

  • Correct terminology to use for description of osteochondral lesions is always a point of confusion for residents, in part because it has been and continues to be a moving target
  • The term osteochondritis dissecans, though still widely used, has fallen out of favor with many because it implies inflammation (“-itis”) whereas most of these lesions are thought to result from repetitive microtrauma
  • Osteochondral lesion (OCL) or osteochondral defect are the terms preferred by most
  • These are the most common locations for OCLs:
    • Elbow: capitellum
    • Knee: medial or lateral femoral condyle
    • Ankle: talar dome
  • OCLs are a common donor site for joint bodies in adolescents and young adults, so make sure to look closely for migrated fragments
  • MRI is often the next step to evaluate for instability if the patient is being considered for surgery


Images

Red arrows: osteochondral lesion of the capitellum. Yellow arrow: remote avulsion fracture at the humeral attachment of the UCL.

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