Coronal Shear Fractures of the Distal Humerus

Bellato, Enrico; Via, Riccardo Giai; Bachman, Daniel R.; Zorzolo, I.; Marmotti, Antonio; Castoldi, Filippo

doi:10.3390/jfmk7010007

Cited by 34 publications

(8 citation statements)

References 105 publications

(205 reference statements)

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“…In this study, 9 of the 16 fractures occurred in women, which displayed a similar trend to other studies, ranging from 60 to 90% female dominance. This trend could result from poorer bone mineral density and an increased carrying angle than that of men [ 2 , 7 , 21 ]. Capitellar fractures can occur in all age groups.…”

Section: Discussionmentioning

confidence: 99%

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

Gao,

Li,

Xue

et al. 2023

BMC Musculoskelet Disord

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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.

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Section: Discussionmentioning

confidence: 99%

“…Capitellar fractures, which involve the capitellum with or without fractures of the trochlea, are relatively uncommon and comprise only 0.5–1% of all elbow fractures [ 1 , 2 ]. The capitellum forms the anterior and inferior surfaces of the distal humerus at the elbow joint.…”

Section: Introductionmentioning

confidence: 99%

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

Gao,

Li,

Xue

et al. 2023

BMC Musculoskelet Disord

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“…Within this varying morphology exists a challenging pattern; coronal shear fractures. These fractures affect the capitellum, the trochlea, or both, but spare the medial and lateral columns 13 . Isolated fractures of the capitellum account for ~3% to 6% of all distal humerus fractures and isolated trochlea fractures are even less common 13 .…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

“…These fractures affect the capitellum, the trochlea, or both, but spare the medial and lateral columns 13 . Isolated fractures of the capitellum account for ~3% to 6% of all distal humerus fractures and isolated trochlea fractures are even less common 13 . However, in those who sustain an unreconstructible coronal shear fracture that is amenable to EHA, there is a unique opportunity to replace the articular surface of the distal humerus while maintaining the structural integrity of the medial and lateral columns and their attached collateral ligaments.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Ligament Sparing Elbow Hemiarthroplasty: A Novel Technique for the Management of Distal Humeral Fractures

Saleh,

Patterson,

Aillerie

et al. 2024

Techniques in Hand &Amp; Upper Extremity Surgery

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Intra-articular distal humerus fractures present various challenges with a wide array of treatment options. Open reduction internal fixation remains the treatment of choice. In older patient populations with poor bone quality and short-end segment fractures with articular comminution, open reduction internal fixation, however, may bring on unsurmountable technical challenges. Total elbow arthroplasty and elbow hemiarthroplasty (EHA) may offer superior functional outcomes in these cases. During EHA for fractures, the medial and lateral columns are reconstructed with the collateral ligaments to restore elbow stability. We hypothesize that in coronal sheer fracture patterns where the columns are intact, maintaining the native collateral ligaments and columns will provide both an anatomic and stable elbow joint. We introduce the ligament sparing EHA technique for unreconstructible coronal shear fractures. We describe this novel technique and compare our postoperative outcomes in 2 patients who underwent this surgery to those described in the literature. The postoperative Disabilities of the Arm, Shoulder, and Hand scores for the 2 patients were 13.8 and 10.3, respectively. The Mayo Elbow Performance Score for the 2 patients were 80 and 85, respectively. The operative arm presented a grip strength of 82% and 89% when compared with the contralateral arm, for the patients respectively. The range of motion varied between 78% and 100% of the contralateral arm for both patients. Although our results are promising and the ligament sparing EHA technique may be a more anatomic option in certain fracture patterns, further research with larger cohorts and multiple surgeons is needed to reinforce our results.

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“…oronal shear fractures are partial or complete distal humerus articular fractures without the involvement of the columns, which can affect the capitellum, trochlea, or both. These kinds of fractures are rare injuries accounting for less than 1% of elbow fractures [1][2][3] . Several classification systems exist for classifying the coronal shear fractures [4][5][6][7][8] .…”

mentioning

confidence: 99%

Reconstruction of the Distal Humerus in a Post-traumatic Arthritic Elbow with a Frozen Osteochondral Allograft Using CT-based Preoperative 3D Planning

Russo

Guastafierro

Mortellaro³

et al. 2023

JBJS Case Connector

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Case: We present a young patient with malunion of the Type IV distal humeral coronal shear fracture and post-traumatic arthritis of the elbow joint. He was treated with a frozen osteochondral allograft transplant using CT-based preoperative 3D planning. At 64 months after surgery, both the clinical and radiological results were satisfactory and no complications had been reported. Conclusion:The precision of computer-aided surgical planning could assist in preoperative designing and preparation of a personalized elbow osteochondral allograft. Even in a chronic situation, a personalized treatment approach can allow for osseointegration and satisfactory clinical results.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C79).

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Coronal Shear Fractures of the Distal Humerus

Cited by 34 publications

References 105 publications

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

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

Ligament Sparing Elbow Hemiarthroplasty: A Novel Technique for the Management of Distal Humeral Fractures

Reconstruction of the Distal Humerus in a Post-traumatic Arthritic Elbow with a Frozen Osteochondral Allograft Using CT-based Preoperative 3D Planning

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