The value of using radiographic criteria for the treatment of persistent symptomatic olecranon physis in adolescent throwing athletes.

Abstract

Previously published reports present a variety of nonoperative and operative treatments for a persistent olecranon physis. However, the radiographic indication for the operative treatment is not clear. Our radiographic classification of persistent olecranon physis is helpful in formulating treatment decisions. Cohort study; Level of evidence, 3. Sixteen male baseball players with persistent olecranon physis were retrospectively evaluated. The mean age at first presentation was 14.7 years (range, 12-17 years). The lesion was classified into 2 stages based on radiographic appearance. Stage I demonstrated widening of the olecranon epiphyseal plate when compared with the contralateral elbow on the lateral view. Sclerotic change indicated stage II. All patients underwent nonoperative treatment for at least 3 months. Follow-up radiographs were taken at 1-month intervals. Operative treatment was provided to the patients whose condition had failed to improve after nonoperative treatment. Of the 16 patients, 12 had stage I lesions and 4 had stage II lesions. Nonoperative management produced healing in 91.7% of patients with stage I lesions and none of the patients with stage II lesions. Our radiographic classification of persistent olecranon physis is useful for treatment decision making. In addition, our results demonstrated that sclerotic change is a high predictive indicator of the need for operative treatment.