0:00

In the last case, we saw a little divot in the trochlea.

0:04

Here.

0:04

That was an osteochondral lesion.

0:07

Well, here's another case of a little

0:09

divot, but this is a much more serious condition.

0:13

This is a result of avascular necrosis

0:17

to the trochlea, which causes a fishtail deformity of the elbow.

0:22

They call it a fishtail.

0:24

It's because

0:26

both the condyles come down, like so, and like so.

0:30

And I'll draw that for you in a little bit, looking like the tail of a fish.

0:34

What's happening?

0:36

So the history here is very, very important.

0:39

This person, maybe four or five years ago, had a supracondylar fracture.

0:45

Remember we talked about a supracondylar fracture?

0:47

Where does it happen?

0:48

It happens right here where the bone is very, very thin.

0:53

So at one point, this person had a supracondylar fracture.

0:56

It healed up, but then a few years later start having pain.

1:00

He started having pain.

1:01

And when we reimaged them...

1:02

This is an arthrogram.

1:03

This is a T1-weighted sequence with intra articular contrast.

1:08

This is a DESS sequence.

1:09

And that's fluid over here.

1:11

When we did this, we saw this big divot over here.

1:14

And we also saw osteochondral lesions

1:17

involving the radius here, the capitulum over here, and also parts of the trochlea.

1:26

So multifocal areas of osteochondral lesion

1:30

and cystic changes and degeneration, and even a little bit osteophyte formation.

1:35

So these are all sequela of longterm abnormality in that joint because

1:39

of incongruity and avascular necrosis in the lateral trochlea.

1:44

And on the lateral view,

1:46

on the sagittal view, you can see there's even a little bit

1:49

of cartilage fissuring that's happening over here.

1:52

All part of this entire process.

1:54

And it all stemmed from the fact that this person, years ago, had a supracondylar

2:02

fracture, something that's very, very common in kids.

2:05

But not everybody who has this fracture

2:07

goes on to develop this abnormality or this complication.

2:10

It's rare, but it's important enough that a good orthopedic surgeon will say

2:15

to the child's mother or the child, hey, you know what?

2:18

Your elbow is probably going to be fine after the supracondylar fracture,

2:21

but in a few years, if you start having pain for no apparent

2:25

reason, come back and see me, because this could be one of those

2:29

complications that's happening. In the next vignette,

2:32

I'm going to show you why this happens.