Wilson Philip L, Wyatt Charles W, Searls William C, Carpenter Connor M, Zynda Aaron J, Vite Lorenzo, Ellis Henry B
Texas Scottish Rite Hospital for Children, Dallas, Texas.
University of Texas Southwestern Medical Center, Dallas, Texas.
J Bone Joint Surg Am. 2021 Sep 15;103(18):1675-1684. doi: 10.2106/JBJS.20.01863.
Radial head stress fractures (RHSFs) and capitellar osteochondritis dissecans (COCD) are rare but may be seen in gymnasts. The purpose of this study was to compare the clinical and radiographic characteristics and the outcomes of RHSF and COCD in pediatric and adolescent gymnastic athletes.
Classical gymnasts and competitive tumblers ≤18 years of age presenting with RHSF or COCD over a 5-year period were reviewed. Radiographic characteristics, clinical characteristics, and patient-reported outcomes were compared.
Fifty-eight elbows (39 with COCD and 19 with RHSF) were studied; the mean patient age was 11.6 years. Gymnastic athletes with RHSF competed at a higher level; of the athletes who competed at level ≥7, the rate was 95% of elbows in the RHSF group and 67% of elbows in the COCD group. The RHSF group presented more acutely with more valgus stress pain than those with COCD (p < 0.01) and demonstrated increased mean valgus angulation (and standard deviation) of the radial neck-shaft angle (13° ± 3.8° for the RHSF group and 9.3° ± 2.8° for the COCD group; p < 0.01) and decreased mean proximal radial epiphyseal height (3.7 ± 0.6 mm for the RHSF group and 4.2 ± 1.5 mm for the COCD group; p < 0.01). At a minimum of 2 years (range, 2.0 to 6.3 years), the RHSF group reported fewer symptoms; the QuickDASH (abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score was 1.75 ± 3.84 points for the RHSF group and 7.45 ± 7.54 points for the COCD group (p < 0.01). Those at a high level (≥7) were more likely to return to gymnastics independent of pathology, with the RHSF group reporting higher final activity levels with the mean Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) score at 26.0 ± 7.5 points compared with the COCD group at 23.6 ± 5.7 points (p < 0.05). Of the 9 patients with bilateral COCD, only 3 (33%) returned to gymnastics.
RHSF with features similar to the more familiar COCD lesion may present in gymnastic athletes. Those with RHSF may present more acutely with a high competitive level and may have a better prognosis for return to competitive gymnastics than those with COCD.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
桡骨头应力性骨折（RHSFs）和肱骨小头剥脱性骨软骨炎（COCD）较为罕见，但在体操运动员中可能会出现。本研究的目的是比较儿童和青少年体操运动员中RHSF和COCD的临床及影像学特征以及治疗结果。
回顾了5年间年龄≤18岁、患有RHSF或COCD的古典体操运动员和竞技技巧运动员。比较了影像学特征、临床特征以及患者报告的治疗结果。
共研究了58例肘部病例（39例为COCD，19例为RHSF）；患者平均年龄为11.6岁。患有RHSF的体操运动员竞技水平更高；在竞技水平≥7级的运动员中，RHSF组肘部比例为95%，COCD组肘部比例为67%。与COCD患者相比，RHSF组出现内翻应力疼痛更为急性（p<0.01），并且桡骨颈干角的平均内翻角度（及标准差）增大（RHSF组为13°±3.8°，COCD组为9.3°±2.8°；p<0.01），桡骨近端骨骺平均高度降低（RHSF组为3.7±0.6mm，COCD组为4.2±1.5mm；p<0.01）。至少随访2年（范围为2.0至6.3年）时，RHSF组报告的症状较少；RHSF组的QuickDASH（手臂、肩部和手部功能障碍问卷简版）评分为1.75±3.84分，COCD组为7.45±7.54分（p<0.01）。高水平（≥7级）运动员无论病情如何更有可能恢复体操运动，RHSF组报告的最终活动水平更高，特殊外科医院儿童功能活动简表（HSS Pedi - FABS）平均评分为26.0±7.5分，而COCD组为23.6±5.7分（p<0.05）。在9例双侧COCD患者中，只有3例（33%）恢复了体操运动。
体操运动员中可能会出现具有与更常见的COCD病变相似特征的RHSF。与COCD患者相比，RHSF患者可能起病更急、竞技水平更高，恢复竞技体操运动的预后可能更好。
预后性III级。有关证据水平的完整描述，请参阅作者须知。
