Osteochondritis dissecans of the capitellum

AP (image 1) and lateral (image 2) radiograph of the elbow in an adolescent with elbow pain shows osteochondritis dissecans of the capitellum (arrow). Osteochondritis dissecans may occur due to repetitive microtrauma. The most common location is in the lateral aspect of the medial femoral condyle. Other, less common locations of occurrence include the capitellum and talus.

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AP (image 1) and oblique (image 2) radiographs of the ankle show a small avulsion fracture (arrow) of the lateral aspect of the talus and an osteochondral lesion (arrowhead) of the medial talar dome. Osteochondral lesions or osteochondritis dissecans most commonly occurs at the lateral aspect of the medial femoral condyle in the knee. Other common locations include the capitellum and talar dome. In the ankle, medial talar dome osteochondral lesions are usually not associated with a traumatic injury while lateral lesions are associated with trauma.

Sagittal PD FS MR image in the same patient shows an osteochondral lesion (osteochondritis dissecans or OCD) of the mid capitellum. This is the donor site for the osteochondral body visualized in the olecranon fossa on the prior image. The intra-articular body on the prior image is likely larger than this donor site due to nourishment of the fragment by the synovial fluid. These fragments can become synovialized and hidden from the arthroscopist at surgery. Capitellar OCD classically occurs in little league pitchers due to the repetitive valgus stresses of overhead throwing.

AP (image 1) and lateral (image 2) radiograph of the elbow shows an avulsion fracture (arrow) of the medial epicondyle. The medial epicondyle is entrapped within the elbow joint. The CRITOE mnemonic refers to the order of ossification of the different structures and helps to identify when the medial epicondyles is "missing". The order of ossification of the elbow is the capitellum, head of the radius, internal (medial) epicondyle, trochlea, olecranon, and external (lateral) epicondyle. In this patient, the medial epicondyle is not visible in its normal location and should not be confused with the unossified trochlea.

Lateral (image 1) and AP radiograph (image 2) of the elbow in a child show a supracondylar fracture (arrow). Supracondylar fractures are the most common fracture of the elbow in children. On the lateral view, findings of a supracondylar fracture include a posterior joint effusion causing uplifting of the fat pad (arrowhead) and posterior displacement of the capitellum. Normally, the anterior humeral line (dashed line) bisects the anterior third of the capitellum. With supracondylar fractures, the anterior humeral line may no longer bisect the capitellum.

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