Background: There is a need to clarify the usefulness of and problems associated with cylindrical costal osteochondral autograft for reconstruction of large defects of the capitellum due to osteochondritis dissecans. Methods: Twenty-six patients with advanced osteochondritis dissecans of the humeral capitellum were treated with use of cylindrical costal osteochondral autograft. All were males with elbow pain and full-thickness articular cartilage lesions of ‡15 mm in diameter. Clinical, radiographic, and magnetic resonance imaging outcomes were evaluated at a mean followup of thirty-six months (range, twenty-four to fifty-one months). Results: All patients had rapid functional improvement after treatment with costal osteochondral autograft and returned to their former activities, including sports. Five patients needed additional minor surgical procedures, including screw removal, loose body removal, and shaving of protruded articular cartilage. Mean elbow function, assessed with use of the clinical rating system of Timmerman and Andrews, was 111 points preoperatively and improved to 180 points at the time of follow-up and to 190 points after the five patients underwent the additional operations. Mean elbow motion was 126°of flexion with 16°of extension loss preoperatively and improved to 133°of flexion with 3°of extension loss at the time of follow-up. Osseous union of the graft on radiographs was obtained within three months in all patients. Revascularization of the graft depicted on T1-weighted magnetic resonance imaging and congruity of the reconstructed articular surface depicted on T2-weighted or short tau inversion recovery imaging were assessed at twelve and twenty-four months postoperatively. Functional recovery was good, and all patients were satisfied with the final outcomes. Conclusions: Cylindrical costal osteochondral autograft was useful for the treatment of advanced osteochondritis dissecans of the humeral capitellum. Functional recovery was rapid after surgery. Additional operations were performed for five of the twenty-six patients, whereas the remaining patients showed essentially full recovery within a year. All patients were satisfied with the results at the time of short-term follow-up. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. O steochondritis dissecans of the humeral capitellum is a common sports-related disorder in young athletes, especially baseball players and gymnasts. With severe osteochondritis dissecans, the damaged articular cartilage detaches from the capitellum and there is a full-thickness articular cartilage defect and radiocapitellar incongruity. Treatment for early-stage osteochondritis dissecans is principally nonoperative. When the lesion progresses to a large, full-thickness articular cartilage defect, treatment remains challenging. In the elbow, arthroscopic debridement has been widely applied with good Disclosure: None of the authors received payments or services, either directly or indirectly (...

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Background Corrective osteotomy using dorsal plates and structural bone graft usually has been used for treating symptomatic distal radius malunions. However, the procedure is technically demanding and requires an extensive dorsal approach. Residual deformity is a relatively frequent complication of this technique. Questions/purposes We evaluated the clinical applicability of a three-dimensional osteotomy using computeraided design and manufacturing techniques with volar locking plates for distal radius malunions. Patients and Methods Ten patients with metaphyseal radius malunions were treated. Corrective osteotomy was simulated with the help of three-dimensional bone surface models created using CT data. We simulated the most appropriate screw holes in the deformed radius using computer-aided design data of a locking plate. During surgery, using a custom-made surgical template, we predrilled the screw holes as simulated. After osteotomy, plate fixation using predrilled screw holes enabled automatic reduction of the distal radial fragment. Autogenous iliac cancellous bone was grafted after plate fixation. Results The median volar tilt, radial inclination, and ulnar variance improved from À20°, 13°, and 6 mm, respectively, before surgery to 12°, 24°, and 1 mm, respectively, after surgery. The median wrist flexion improved from 33°b efore surgery to 60°after surgery. The median wrist extension was 70°before surgery and 65°after surgery. All patients experienced wrist pain before surgery, which disappeared or decreased after surgery. Conclusions Surgeons can operate precisely and easily using this advanced technique. It is a new treatment option for malunion of distal radius fractures.

Three-dimensional corrective osteotomy with the use of a custom-made surgical template that is designed and produced on the basis of computer simulation is a feasible and useful treatment option for cubitus varus deformity.

Computer-assisted osteotomy can provide excellent radiographic and clinical outcome for the treatment of malunited diaphyseal forearm fractures. Satisfactory restoration of forearm motion can be achieved even in relatively long-standing cases in adults.