Clinical outcomes of capitellar fractures with posterior comminution treated with Herbert screws combined with metacarpal locking plates

Abstract

Background The treatment of Dubberley type B capitellar fractures, which are frequently complicated, is widely debated. This study aimed to investigate the prognostic factors and clinical outcomes of Dubberley type B capitellar fractures treated with Herbert screws combined with posterior buttress plates. Methods Seven men and nine women (aged 30–68 years) with Dubberley type B capitellar fractures were operated on with Herbert screws combined with posterior buttress plates. The patients were classified into Dubberley types IB (seven), IIB (four), and IIIB (five). Complications and bone union were observed, and functional outcomes were evaluated by the Mayo Elbow Performance Index (MEPI). Results All patients were followed up for a mean period of 23.5 months (12–30 months). All fractures healed in 8–14 weeks (mean, 10.5 weeks). No cases of non-union, elbow instability, or avascular necrosis occurred. Degenerative arthritis occurred in 7 (44%) and heterotopic ossification in 11 (69%) patients. The median MEPI score was 92.5 (interquartile range, 85–100) points, with 11 reporting excellent, 3 good, and 2 fair outcomes. The MEPI scores of type IIIB fractures were significantly lower than those of types IB and IIB fractures, while the MEPI scores of type IB and IIB fractures did not differ significantly. Conclusions Dubberley type IIIB capitellar fractures with multiple articular fragments have a poorer prognosis than type IB and IIB fractures. However, Herbert screw fixation combined with posterior metacarpal locking plates is feasible, providing satisfactory recovery of elbow joint function.

Surgical Management of a Three-Month-Old Mal-United Dubberley Type 2A Distal Humerus Fracture: A Case Report

“…Isolated fractures of the trochlea are even more rare [2]. The capitellum is spherical in nature made by the anterior and inferior surface of the distal humerus and fracture of which the elbow joint unstable [3]. Women are more prone to shear fractures of the distal humerus which can be attributed to recurvatum, poor bone stock, and cubitus valgus.…”

“…McKee described the partial articular fractures of the trochlea and capitellum and gave a classification system [7]. Dubberley gave a classification system focusing on the treatment as well as the outcome of coronal fractures of the capitellum and it considers the involvement of the trochlea and the posterior communication [3].…”