Sports Medicine: Just the Facts

• Operative treatment for displaced articular fractures
  aims for anatomic reduction and early motion to min-
  imize stiffness. Intra-articular distal humerus frac-
  tures tend to be extremely complicated to treat
  operatively.

CAPITELLAR FRACTURE

• Rare!<1% of all elbow fractures (Scheling, 2002).
  Often associated with radial head fractures. Diagnosis
  may be difficult, and the lateral plain film must be
  carefully checked. A computed tomography(CT) scan
  may be necessary to better delineate the fracture type.
  Nonoperative treatment for nondisplaced fractures.


• There are three basic types of capitellar fractures:
  Hahn-Steinthal fracture includes a large portion of
  bone with the capitellar articular surface, and usually
  is able to be primarily reduced, and fixed operatively.
  The Kocher-Lorenz fragment involves a small amount
  of articular surface of the capitellum only, and must
  often be excised. A third type of fracture is commin-
  uted and is also difficult to fix.


• Early motion is mandatory after these injuries.

RADIAL HEAD FRACTURES

• Common: 20–30% of elbow fractures (Scheling,
  2002). Adults tend to sustain radial head as opposed to
  neck fractures. May be isolated or associated with
  elbow dislocation, ulnar shaft fractures, distal radial
  joint injury (Essex-Lopresti lesion), or carpal frac-
  tures, as well as additional fracture patterns.


• Must rule out associated medial collateral ligament
  (MCL) injury, interosseus membrane, distal radio-
  ulnar joint(DRUJ) injury.


• Operative indications include displacement greater
  than 2 mm, mechanical block to motion (pain may be
  ruled out as cause with intra-articular lidocaine injec-
  tion), greater than 20–30% articular depression, or
  open fracture (Scheling, 2002). Surgical options
  depend on fracture type as well as associated lesions
  and include excision, ORIF or hemiarthroplasty.
  Radial head should never be excised if interosseus lig-
  ament or MCL injury.

OLECRANON FRACTURE

• Nondisplaced fractures <2 mm are treated nonopera-
  tively with long arm casting. Care must be taken to
  avoid prolonged immobilization and stiffness
  (Scheling, 2002).
  
  
  • Displaced fracture required ORIF, with technique
    dependent upon fracture pattern stability. Although
    excision of up to 50% of olecranon has been described
    (Scheling, 2002), this should only be used in very low
    demand patients, and not in the athletic population.
  
  
  
  

CORONOID FRACTURES

• Caused by humeral hyperextension. Associated with
  dislocation of elbow 10–33% of time. Coronoid-
  trochlear articulation provides up to 50% of elbow
  stability (Scheling, 2002).
  •Treatment depends on fracture stability pattern, which
  is defined by amount of coronoid involved in fracture.
  Greater than 50% involvement requires ORIF, less
  than 50% fracture may be treated nonoperatively if it
  is stable.


• As with most elbow fractures, basic treatment plan is
  to obtain stability so as to allow early motion.

OSTEOCHONDRITIS DESSICANS

• Osteochondritis dessicans (OCD) of the capitellum
  occurs in adolescent and young adult athletes who are
  involved in repetitive upper extremity exercises.


• Throwers, gymnasts, and weight lifters are particularly
  susceptible.


• Etiology involves microtrauma, but exact cause is
  uncertain.


• AP and lateral radiographs are usually sufficient for
  diagnosis, but MRI or CT may be helpful to further
  delineate extent of lesion. There may be a localized area
  in capitellum without rarefaction and crater formation.


• Osteochondrosis of the capitellum or Panner’s disease
  occurs in children age 4–8 years and involves entire
  ossific nucleus self-limiting with conservative treat-
  ment (Schenck, Jr and Goodnight, 1996).


• OCD of the capitellum occurs in individuals 10 years
  old or greater and involves a portionof the capitellum.
  It is believed to be due to valgus high stress forces
  caused during the acceleration phase of throwing,
  when the capitellum becomes loaded. Symptoms
  include poorly defined lateral elbow pain, with later
  stages of disease showing catching and locking. Laxity
  of the MCL may be present. Permanent deformity may
  result. Strict restriction from throwing for 8–12 weeks
  or until full, pain-free motion is restored for nondis-
  placed lesion with intact articular cartilage (Schenk
  and Goodnight, 1996).


• Indications for surgery include partially or completely
  detached fragment. Treatment options are dependent
  on lesion type and chronicity and include removal,

296 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE