Open Reduction and Internal Fixation of Capitellar Fractures with Headless Screws

Abstract

Despite the presence of greater flexion contractures at the time of follow-up in elbows with Type-IV fractures or fractures with an ipsilateral radial head fracture, good to excellent outcomes with functional ulnohumeral motion can be achieved following internal fixation of these complex fractures. Type-IV injuries may be more common than previously thought; such fractures often are associated with metaphyseal comminution or a radial head fracture and may require supplemental fixation.

Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws

“…In Ruchelsman's series, 50% of the type IV fractures identified had associated posteroinferior metaphyseal comminution and 2 fractures had separate trochlear fracture fragments. 27 In accordance with the Dubberley classification, 4 of these would have qualified as 2B fractures, and 2 as type 3 fractures. 5 Evaluation of the fractures in this manner may have further supported the present findings and those demonstrated by Dubberley that better outcomes are to be expected in large coronal fractures lacking significant comminution.…”

“…14,18,24,26,27,30 With the exception of Ruchelsman et al, all of the above studies are limited by the small patient size ranging from 4 to 6 patients. 27 Our study is unique in that it has a larger sample size than any other previously reported in the literature, allowing us to break our patients into subgroups for statistical comparison. For example, there was no difference in postoperative BM scores and ROM after headless compression screw fixation of Dubberley types-1 and -2 fractures.…”

“…5 This is in contrast to Ruchelsman et al, who reported that Bryan and Morrey (McKee) type IV fractures resulted in greater flexion contractures, lower total flexion, and lower net ulno-humeral arc when compared to Bryan-Morrey type-I fractures. 27 This discrepancy can be better explained by looking closer at these different classification schemes. The Bryan and Morrey (McKee) type IV fracture correlates with the Dubberley type 2 classification where the capitellum and trochlea are 1 large fragment.…”

Intermediate-term outcomes for floating elbow and floating elbow variant injuries

“…The ASES score can also be compared more easily with other injury states because multiple conditions have been evaluated with this scoring system. 5,6,7,12,17,19 Previous studies have attempted to identify factors that predict functional outcomes after floating elbow injury. Solomon et al 21 showed that patients with associated nerve injury have lower functional outcomes.…”

Arthroscopic-Assisted Reduction and Percutaneous Fixation for Coronal Shear Fractures of the Distal Humerus: Report of Two Cases

“…7 Open treatments are simple, with excellent results. [12][13][14] Arthroscopic surgery has advantages, including minimized soft tissue dissection and easier evaluation of associated lesions especially involving the medial joint, although elbow arthroscopy is a challenging procedure and there are inherent risks to the neurovascular structures. 15 Holt et al stated that the criterion for arthroscopic management in articular fractures of distal humerus is capitellum fracture without comminution.…”