Osteochondritis Dissecans of the Elbow: Concepts of Etiology

Osteochondritis dissecans (OCD) is a clinical condition of the capitellum which occurs most commonly in the adolescent athletes especially in repetitive elbow activities such as gymnasts, pitchers, and swimmers. The lesion is localized to an area of the capitellar subchondral bone plate, which is only a single trabecular layer thick (100 μm). The area involved is supplied by end vessels from the lateral condyle. The subarticular venous plexus consists of parallel veins located in the gutters of the subchondral bone plate. With repeated trauma of throwing, the fracture fails to heal. Obstruction of the venous drainage will lead to localized ischemia, edema of the intraosseous fat, and subsequently a localized compartment syndrome of the bone. Failure of healing of the fragment leads to separation, loose body formation, and finally degenerative osteoarthritis.