Capitellum Fractures
Posted on Jun 28, 2012 in
DNB Short Notes
Introduction |
- Represent 1% of elbow fractures
- occur in coronal plane
- very little soft tissue attachment so they often displace
- Mechanism
- fall on outstretched hand
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Classification |
- Bryan and Morrey classification
- Type I: (Hahn-Steinthal fracture)
- complete fracture of capitellum
- Type II: (Kocher-Lorenz fracture)
- Superficial osteochondral fracture fragment
- Type III
- McKee modification
- Type IV
- coronal shear fracture including capitellum and trochlea
- "double bubble" seen on lateral radiograph representing the capitellum and trochlea
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Presentation |
- Symptoms
- elbow pain, swelling, and stiffness
- Physical exam
- may have mechanical block
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Imaging |
- Radiographs
- best demonstrated on lateral radiograph
- CT
- obtain CT scan to delineate fracture anatomy
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Treatment |
- Nonoperative
- posterior splint immobilization for 3 weeks
- indications
- nondisplaced (< 2mm) Type I fractures
- nondisplaced (< 2mm) Type II fractures
- Operative
- open reduction and internal fixation
- indications
- displaced Type I fractures
- Type IV fractures
- technique
- screw fixation (may use headless Herbert screw)
- avoid disruption of the blood supply that comes from the posterolateral aspect of the elbow
- fixation should allow early ROM
- fragment excison
- indications
- displaced (>2mm) Type II fractures
- displaced (>2mm) Type III fractures
- contraindicated if other injuries that may create instability
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Complications |
- Complications of operative treatment
- nonunion (1-11% with ORIF)
- ulnar nerve injury
- heterotopic ossification (4% with ORIF)
- AVN of capitellum
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