Osteochondritis Dissecans

MANUAL MINORS

Osteochondritis dissecans (OCD) is a condition in which a portion of cartilage and the underlying bone in a joint loses its blood supply, causing that area to weaken and, in some cases, detach, leading to pain and limited movement.

It primarily affects adolescents and young adults, especially those involved in sports with repetitive, high-impact movements. In the elbow, OCD often affects the articular surface of the lateral condyle of the humerus.

Diagnosis

Diagnosis is suspected based on symptoms such as chronic pain, stiffness, swelling, and joint locking in the elbow, which worsen with physical activity. In advanced stages, instability or a “locking” sensation may occur due to the detachment of the bone fragment. Initial X-rays may show changes in the articular surface, but magnetic resonance imaging (MRI) is the most sensitive method to evaluate the extent of cartilage damage and the stability of the bone fragment.

Differential Diagnosis

Condition	Key Characteristics
Osteochondral fracture	Acute trauma with pain and joint locking, fragment visible on X-rays.
Osteoarthritis	Chronic pain and joint stiffness, typically in older adults.
Septic arthritis	Severe pain with fever and signs of joint infection.
Traumatic synovitis	Post-traumatic swelling and pain, without bone detachment.
Elbow dislocation	Obvious deformity following trauma, acute pain, and loss of mobility.

Emergency Management

Emergency management focuses on controlling pain and inflammation. Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) are administered, and the joint may be temporarily immobilised to prevent worsening symptoms.

If joint locking occurs due to a loose fragment, it is important to refer the patient for orthopaedic evaluation. In early stages, conservative treatment may be effective, but advanced cases or those with detached fragments will require surgical intervention.

Definitive Treatment

Definitive treatment depends on the severity of the lesion and the stability of the bone fragment. In early stages, conservative treatment includes rest, restriction of physical activity, and physiotherapy to strengthen muscles and improve mobility.

If the fragment is loose or the lesion does not respond to conservative treatment, arthroscopic surgery may be required to remove or fix the osteochondral fragment. In severe cases, microfracture of the affected area may be necessary to stimulate cartilage regeneration. Postoperative rehabilitation is essential to restore joint function.