Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-E/8.1

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1 Goals top

The main goals of treatment of these osteochondral lesions are:

  • Atraumatic removal of small fragments
  • Pain-free and normal elbow function

2 Suitable fracture types top


The elbow is a complex joint and has a large area of articular cartilage. Osteochondral fragments can originate from any part of the joint surface. The capitellum is the most commonly affected portion of the joint.

3 Patient preparation top


This procedure is normally performed with the patient in a supine position.

See also the additional material on preoperative preparation.

4 Fragment excision top

If it is appreciated at the time of arthrotomy or arthroscopy that the fragment(s) is too small to reattach it should be removed.

The approach is usually lateral by mini-arthrotomy, but arthroscopy is an alternative.

Multiple fragments might be present and preoperative MRI can help to determine their location. All substantial cartilagenous fragments should be excised.

If the fragment bed is not fresh (osteochondritis dissecans) it may be debrided and then treated with drilling or micro-fractures.

v1.0 2016-12-01