Management of isolated coronal shear fractures of the humeral capitellum with Herbert screw fixation through anterolateral approach

Abstract

BackgroundDue to the intraarticular and complex nature of the coronal shear fracture of the humeral capitellum and its rarity, it has been difficult to formulate a universally accepted method of surgical management. The purpose of this study is to retrospectively evaluate the clinical outcomes of 15 patients with isolated coronal shear fractures of the capitellum treated by Herbert screw fixation through anterolateral approach, and to address the safety and tips for this surgical procedure.MethodsThis retrospective study included 15 isolated coronal shear fractures of the capitellum without posterior involvement, which were classified according to the Dubberley classification as 11 type 1A fractures and 4 type 3A fractures. All fractures were treated with Herbert screws fixation via the anterolateral approach. Clinical and radiographic evaluation was performed regularly, with a mean follow-up of 29 months.ResultsThe mean operative time was 81 min. There were no wound healing problems or infection. One incomplete posterior interosseous nerve injury occurred, which recovered soon without residual compromise. All fractures healed well. At the final follow-up, the average range of motion was 134°in flexion-extension and 172°in supination-pronation. There was no significant difference between the affected and the unaffected elbows with regard to motion in flexion-extension or flexion-extension. The average Mayo Elbow Performance Index Score was 93 with 11 excellent and 4 good. No evidence of avascular necrosis, posttraumatic osteoarthritis, or heterotrophic ossification was found.ConclusionOpen reduction and internal fixation using Herbert screws through a anterolateral approach is a reliable and effective treatment for coronal shear fractures of capitellum, and able to achieve stable fixation and restoration of a functional range of motion.

Functional Outcome of a Coronal Shear Fracture of the Capitellum Managed by Herbert Screw Fixation Using the Anterolateral Surgical Approach

“…During every follow-up, the elbow range of motion, pain, and stability of the elbow joint were assessed clinically. Also, Mayo Elbow Performance Index (MEPI) scoring [2] was done at 12 months for every patient. Serial radiographs were done to evaluate the healing of the fracture, post-traumatic osteoarthritis, and avascular necrosis.…”

“…The mechanism of injury is usually axial loading through the radial head. Both conservative and operative methods have been tried for the management of these fractures [2]. In the present scenario, open reduction and internal fixation, which provides a stable congruent joint, is the most preferred treatment strategy.…”

“…In the present scenario, open reduction and internal fixation, which provides a stable congruent joint, is the most preferred treatment strategy. However, because of the complexity of these intra-articular fractures, surgical exposure and fracture fixation are difficult [2][3][4][5][6][7][8][9].…”

“…In a coronal shear capitellar fractures, the lateral approach is commonly used for exposure of the elbow [2][3][4][5][6][7][8][9]. But with the lateral approach, the exposure of the medial articular extension and trochlea is inadequate.…”

“…Regarding the fixation of the capitellar fracture, various implants, such as mini-fragment screws, Herbert screws, and bioabsorbable rods, have been used. Herbert screw fixation provides compression at the fracture site, stable fixation, and no intra-articular prominence of the implant [2,[12][13][14][15][16][17][18][19][20]. There is no accepted guideline regarding the method of internal fixation for these fractures [2].…”