Kozo Shimada1, Hiroyuki Tanaka1, Taiichi Matsumoto2, Junichi Miyake3, Haruhisa Higuchi4, Kazushige Gamo4, Takeshi Fuji1. 1. Department of Orthopaedic Surgery, Osaka Koseinenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan. E-mail address for K. Shimada: k-shimada1960@nifty.com. 2. Department of Orthopaedic Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan. 3. Department of Orthopaedics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita Osaka 565-0871, Japan. 4. Department of Orthopaedic Surgery, Hoshigaoka Koseinenkin Hospital, 4-8-1 Hoshigaoka, Hirakata, Osaka 573-8511, Japan.
Abstract
INTRODUCTION: We describe our technique of cylindrical costal osteochondral autograft for elbows with advanced osteochondritis dissecans. STEP 1 PREPARE AND POSITION THE PATIENT: Mark the ipsilateral (fifth or sixth) rib. STEP 2 EXCISE/DEBRIDE THE LESION AND CREATE A CYLINDRICAL HOLE: Debride necrotic fibrous tissue completely. STEP 3 ELEVATE THE COSTAL OSTEOCHONDRAL JUNCTION: Elevate the graft carefully from the periosteum and perichondrium to avoid damage to the pleura. STEP 4 PREPARE THE OSTEOCHONDRAL AUTOGRAFT: Shape the harvested osteochondral junction like a cone about 18 mm in height, including a 5-mm-high cartilage cap. STEP 5 PLACE THE GRAFT INTO THE DEFECT AND CLOSE: After packing the grafts, shape and contour the cartilage surface to fit the radial head using a scalpel. STEP 6 POSTOPERATIVE TREATMENT: Most patients are able to perform normal daily activities in a few days or a week, but they are not allowed to play sports for three months. RESULTS: Between 2006 and 2010, we performed this operation in forty-three patients with severe osteochondritis dissecans of the humeral capitellum, and twenty-six cases were followed for more than twenty-four months12. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: We describe our technique of cylindrical costal osteochondral autograft for elbows with advanced osteochondritis dissecans. STEP 1 PREPARE AND POSITION THE PATIENT: Mark the ipsilateral (fifth or sixth) rib. STEP 2 EXCISE/DEBRIDE THE LESION AND CREATE A CYLINDRICAL HOLE: Debride necrotic fibrous tissue completely. STEP 3 ELEVATE THE COSTAL OSTEOCHONDRAL JUNCTION: Elevate the graft carefully from the periosteum and perichondrium to avoid damage to the pleura. STEP 4 PREPARE THE OSTEOCHONDRAL AUTOGRAFT: Shape the harvested osteochondral junction like a cone about 18 mm in height, including a 5-mm-high cartilage cap. STEP 5 PLACE THE GRAFT INTO THE DEFECT AND CLOSE: After packing the grafts, shape and contour the cartilage surface to fit the radial head using a scalpel. STEP 6 POSTOPERATIVE TREATMENT: Most patients are able to perform normal daily activities in a few days or a week, but they are not allowed to play sports for three months. RESULTS: Between 2006 and 2010, we performed this operation in forty-three patients with severe osteochondritis dissecans of the humeral capitellum, and twenty-six cases were followed for more than twenty-four months12. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: Yann Glard; André Gay; David Valenti; Christian Berwald; Didier Guinard; Régis Legré Journal: J Hand Surg Am Date: 2006-11 Impact factor: 2.230