Early Lateral Compartment Physeal Closure of the Elbow in Osteochondritis Dissecans of the Adolescent Baseball Players

Jung Hoei Ku; Hyung Lae Cho; Ki Bong Park; Wan Seok Lee

doi:10.5763/kjsm.2018.36.4.180

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Ku, Cho, Park, and Lee: Early Lateral Compartment Physeal Closure of the Elbow in Osteochondritis Dissecans of the Adolescent Baseball Players

Clinical Article

Clinical Sports Medicine

The Korean Journal of Sports Medicine 2018; 36(4): 180-188.

Published online: 7 December 2018

DOI: https://doi.org/10.5763/kjsm.2018.36.4.180

Early Lateral Compartment Physeal Closure of the Elbow in Osteochondritis Dissecans of the Adolescent Baseball Players

Jung Hoei Ku, Hyung Lae Cho, Ki Bong Park, Wan Seok Lee

Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Korea.

Correspondence: Ki Bong Park. Department of Orthopaedic Surgery, Good Samsun Hospital, 326 Gaya-daero, Sasang-gu, Busan 47007, Korea. Tel: +82-51-322-0900, Fax: +82-51-310-9348, 214077@goodhospital.or.kr

Received 7 September 2018 Revised 13 November 2018 Accepted 16 November 2018

The Korean Society of Sports Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to identify bilateral differences of physeal closure of the lateral compartment of the elbow in osteochondritis dissecans (OCD) and related factors with premature physeal closure.

Methods

Initial radiographs of the bilateral elbows in 40 baseball players with OCD (group I) were reviewed for the status of physeal closure of the lateral compartment; capitellum, radial head, lateral epicondyle. Forty baseball players with medial epicondylar apophysitis (group II) were enrolled as a control. Relative status of physeal closure of dominant elbow was defined as early, same, and delayed. Bilateral differences of the status of physeal closure were analyzed between groups, and according to the radiographic stages, extent of the lesions and demographic factors in group I.

Results

Significant early physeal closures of dominant elbows were identified in group I in capitellum (group I, 55%; group II, 3%), radial head (group I, 53%; group II, 3%), and lateral epicondyle (group I 37%; group II, 5%). In group I, advanced stage and extended lesion showed early lateral compartment physeal closure especially in capitellum and radial head, and players with longer career length and limitation of motion showed early closure.

Conclusion

Over the half of the adolescent baseball players with OCD demonstrated early radiocapitellar physeal closures of dominant elbow in initial presentation. Because premature physeal closure contributes to the development of arthritis without appropriate radiocapitellar remodeling, early detection of OCD is essential for prevention of arthritis and successful conservative management.

Keywords: Adolescent baseball players, Osteochondritis dissecans, Premature physeal closure, Radiocapitellar arthritis

Figures and Tables

Fig. 1

Bilateral plain radiographs of 12-year-old pitcher with osteochondritis dissecans in right (R) elbow. (A) Anteroposterior, (B) 45° flexion anteroposterior, and (C) 30o external rotation oblique views show earlier physeal closure than left (L) elbow in capitellum, radial head, and lateral epicondyle. Arrows indicate each lateral compartment physes; lateral epicondyle, capitellum, radial head.

Fig. 2

Bilateral 45° flexion anteroposterior plain radiographs according to the stage of osteochondritis dissecans. (A) Eleven-year-old pitcher in radiolucent stage showed same status of lateral compartment physeal closure in both elbow. (B) Twelve-year-old pitcher in fragmentation stage showed earlier lateral compartment physeal closure than nondominant elbow. (C) Thirteen-year-old pitcher in free stage also showed earlier lateral compartment physeal closure. Arrows indicate each lateral compartment physes; lateral epicondyle, capitellum, radial head. R: right, L: left.

Fig. 3

Bilateral 30° external rotation oblique plain radiographs according to the grade of osteochondritis dissecans. (A) Twelve-year-old pitcher with localized lateral type showed same status of lateral compartment physeal closure in both elbow. (B) Twelve-year-old fielder with radiolucent central type stage also showed same status. (C) Twelve-year-old pitcher with large fragmented central type showed earlier lateral compartment physeal closure than nondominant elbow. (D) Twelve-year-old fielder with extended lateral type showed premature lateral compartment physeal closure and asymmetry of radial head morphology. Arrows indicate each lateral compartment physes; lateral epicondyle, capitellum, radial head. R: right, L: left.

Table 1

Demographic characteristics of groups

Values are presented as mean±standard deviation.

OCD: osteochondritis dissecans, LLE: little leaguer elbow, BMI: body mass index, LOM: limitation of motion.

Table 2

Radiographic stages and locations of lesion in osteochondritis dissecans (group I)

Table 3

Bilateral difference of lateral compartment physeal closure status in both groups

Values are presented as number (%).

OCD: osteochondritis dissecans, LLE: little league elbow, NA: not available.

Table 4

Lateral compartment physeal closure and percentage of early physeal closure according to radiographic stages and locations of lesion in group I

Values are presented as number (%).

^*One case is not available.

Table 5

Comparison of lateral compart physeal closure according to demographic factors in group I

BMI: body mass index, LOM: limitation of motion.

^*One case is not available; ^†Indicates statistically significant difference.

Notes

^{Conflict of Interest} No potential conflict of interest relevant to this article was reported.

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