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Locked Elbow Joint Due to a Cartilage Flap Caused by Osteonecrosis of the Humeral TrochleaA Case Report
Takayuki Ishii, MD1; Masayoshi Ikeda, MD, PhD2; Yuka Kobayashi, MD, PhD1; Ayuko Shimizu, MD1; Ikuo Saito, MD, PhD3; Joji Mochida, MD, PhD1
1 Department of Orthopaedics, Tokai University School of Medicine, 143 Shimogasuya, Isehara, Kanagawa 259-1193, Japan.
2 Department of Orthopaedic Surgery, Shonan Central Hospital, 1-3-43 Hatori, Fujisawa, Kanagawa 251-0056, Japan. Email address: m.ikeda@swg.or.jp
3 Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, 1838 Ishikawacho, Hachioji, Tokyo 192-0032, Japan
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Investigation performed at the Department of Orthopaedic Surgery, Tokai Universiy Hachioji Hospital, Tokyo, Japan



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 May 22;3(2):e52 1-5. doi: 10.2106/JBJS.CC.L.00312
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Extract

Although osteonecrosis of the humeral trochlea is a well-known complication of supracondylar humeral fractures in childhood, its frequency is relatively rare1. We report a case of a young boy with a locked elbow joint due to a cartilage flap caused by osteonecrosis of the humeral trochlea. Osteonecrosis was confirmed by follow-up radiographic examinations. The patient’s mother was informed that data concerning the case would be submitted for publication, and she provided consent.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Masayoshi Ikeda
    Posted on September 30, 2013
    Reply to Dr. Khaled’s comment
    Department of Orthopaedic Surgery, Shonan Central Hospital, Kanagawa, Japan

    Thank you very much for the comment to our case report. Our case had no history of the traumatic dislocation of the elbow joint, but had a supracondylar fracture of the distal humerus. There was no chance of the interposition of the extraarticular tissue such as muscles. In our case, the resected flat cartilage tissue was attached to the posterior edge of the lateral condyle like a flap. The flap seemed to be a meniscus of the knee joint (Figure 1). The histological study showed hyaline cartilaginous tissues with surface fibrous tissues.

    KAMOUN KHALED
    Posted on September 17, 2013
    Osteonecrosis of Humeral Trochlea after Non Displaced Extraarticular Fracture ?
    Pediatric Orthopedic Department, Kassab Institute, Tunis, Tunisia

    We have got the same case a few months ago in a child of the same age and with a history of elbow fracture but with a recent torsion traumatic elbow injury preceding the symptoms.  We believe that in our case this "flap cartilage" may be a degeneration of soft tissue (capsular, epicondylar muscles) incarcerating during elbow dislocation.

    After excision of this "flap" the child recovered full elbow extension.

    In our case, the histological study of the "flap" removed after surgery confirmed capsular fibrosis without any cartilage cells.  Was any histological study done for your  "cartilage" flap ?

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