Bilateral avascular necrosis of the humeral trochleae after chemotherapy

We describe a patient who developed avascular necrosis of both humeral troc hleae after combination chemotherapy for acute lymphoblastic leukaemia. Thi s presented as progressive stiffness of both elbows with little pain. Radio graphy and MRI confirmed the presence of avascular necrosis at both sites. This region corresponds to a watershed between the medial and lateral vascu lar arcades which supply the distal humerus and may explain the susceptibil ity of this bony region to avascular necrosis. Treatment involved capsulect omy of the elbow and removal of osteophytes giving a good functional outcom e on both sides.