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      Demographics and Epidemiology of Osteochondritis Dissecans of the Elbow Among Children and Adolescents

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          Abstract

          Background:

          Osteochondritis dissecans (OCD) of the elbow is a disorder of subchondral bone and articular cartilage, of which the incidence among children is not clearly known.

          Purpose:

          To assess the demographics and epidemiology of OCD of the elbow among children.

          Study Design:

          Cross-sectional study; Level of evidence, 3.

          Methods:

          A retrospective chart review of an integrated health system for the years 2007 through 2011 was performed for patients with elbow OCD aged 2 to 19 years. Lesion location, laterality, and all patient demographics were recorded. OCD incidence was determined for the group as a whole as well as by sex and age group (2-5, 6-11, 12-19 years). Patient differences based on age, sex, and ethnicity were analyzed, and multivariable logistic regression models were used to assess the risk of elbow OCD by group.

          Results:

          A total of 37 patients with 40 OCD lesions fit the inclusion criteria. No lesion was found among 2- to 5-year-olds. A majority of lesions (n = 39, 97.5%) were in the capitellum, and 1 (2.5%) was in the trochlea. Twenty-five patients (67.6%) had right-sided lesions; 9 (24.3%), left-sided; and 3 (8.1%), bilateral. The incidence of elbow OCD for patients aged 6 to 19 years was 2.2 per 100,000 overall and 3.8 and 0.6 per 100,000 for males and females, respectively. The majority of OCD cases were seen in those aged 12 to 19 years, with an incidence of 3.4 per 100,000 versus 0.38 among 6- to 11-year-olds. Multivariable logistic regression analysis revealed a 21.7-times increased odds ratio of elbow OCD among patients aged 12 to 19 years versus 6 to 11 years, and males had a 6.8-times greater odds ratio of elbow OCD than females ( P < .0001 for both). Based on race and ethnicity, non-Hispanic whites had the highest incidence of elbow OCD as compared with all other ethnic groups.

          Conclusion:

          In this population-based cohort study of pediatric elbow OCD, males had almost 7 times the risk of elbow OCD as compared with females, and 12- to 19-year-olds had nearly 22 times the risk of elbow OCD versus 6- to 11-year-olds. In keeping with many prior studies, the majority of patients had right-sided lesions.

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          Most cited references50

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          Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum.

          Indications for the treatment of osteochondritis dissecans of the humeral capitellum have remained unclear. The aims of this study were to analyze the outcomes and to determine the most useful classification for the choice of treatment. The cases of 106 patients with osteochondritis dissecans of the capitellum were studied retrospectively. At the time of the initial presentation, the mean age of the patients was 15.3 years. The capitellar growth plate was open in eighteen patients and closed in eighty-eight. Thirty-six patients were treated nonoperatively. Fifty-five patients underwent fragment removal alone, twelve underwent fragment fixation with a bone graft, and three underwent reconstruction of the articular surface with use of osteochondral plug grafts from the lateral femoral condyle. The mean follow-up period was 7.2 years. The outcomes in terms of pain in the elbow, return to sports, and radiographic findings were analyzed and compared. An osteochondritis dissecans lesion with an open capitellar physis and a good range of elbow motion resulted in a good outcome. Continued elbow stress resulted in the worst outcome in terms of pain and radiographic findings. In patients with a closed capitellar physis, surgery provided significantly better results than elbow rest (p or =20 degrees . For large unstable lesions, fragment fixation or reconstruction of the articular surface leads to better results than simple excision. Prognostic Level II.
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            The demographics and epidemiology of osteochondritis dissecans of the knee in children and adolescents.

            Osteochondritis dissecans (OCD) is a disorder of subchondral bone and articular cartilage whose incidence in children is not clearly known.
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              • Record: found
              • Abstract: found
              • Article: not found

              The incidence of osteochondritis dissecans in the condyles of the femur.

              B Lindén (1976)
              The incidence of osteochondritis dissecans in the condyles of the femur was studied in a defined population and was found to be twice as common in men as in women; the maximum incidence in both sexes being between the ages of 10 and 20. The site of the lesion in the condyles did not differ between age groups. The indicence of diagnosied cases has increased somewhat in recent years but only in men. The incidence in the population is less than has been suggested in the past.
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                Author and article information

                Journal
                Orthop J Sports Med
                Orthop J Sports Med
                OJS
                spojs
                Orthopaedic Journal of Sports Medicine
                SAGE Publications (Sage CA: Los Angeles, CA )
                2325-9671
                19 December 2018
                December 2018
                : 6
                : 12
                : 2325967118815846
                Affiliations
                [* ]Kaiser Permanente Southern California, Los Angeles, California, USA.
                []Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA.
                []School of Medicine, University of Utah, Salt Lake City, Utah, USA.
                []Department of Orthopaedics, Stanford University, Stanford, California, USA.
                [5-2325967118815846] Investigation performed at Kaiser Permanente Southern California, Los Angeles, California, USA
                Author notes
                [*] [§ ]Peter C. Cannamela, BS, School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132, USA (email: pcannamela@ 123456sandiego.edu ).
                Article
                10.1177_2325967118815846
                10.1177/2325967118815846
                6302285
                30622996
                9152955b-e0d1-4b29-b4ef-ab7f128f89bb
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                osteochondritis dissecans,ocd,elbow,epidemiology,pediatric
                osteochondritis dissecans, ocd, elbow, epidemiology, pediatric

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