Outcome after the surgical treatment of the Dubberley type B distal humeral capitellar and trochlear fractures with a buttress plate

Abstract

Relationship between the tilt angle of bipolar radial head prostheses and radiological radiocapitellar instability

Coronal Shear Fractures of the Distal Humerus

“…Although Kirschner wires have been found to provide lower functional outcomes compared with screws, they are an option, particularly in cases characterized by small fracture fragment size [ 64 , 65 ]. They can be used either isolated or in association with other methods, such as external fixation [ 66 , 67 ]. Threaded Kirschner wires are preferred to smooth ones to minimize the risk of migration.…”

“…Even if proper treatment with the plate is performed, posterior comminution can be associated with worse clinical results, as compared to Dubberley subtype A fractures [ 69 ]. A lateral buttress plate can be helpful in cases when comminution is more lateral than posterior [ 25 , 66 , 70 ]. Moreover, lateral placement of the plate avoids posterior stripping of the humeral surface.…”

“…Nonunion is often reported in less than 10% of patient treated surgically [ 2 , 6 , 71 ]. Nonunion is more common in fractures with involvement of the posterior aspect of the lateral column or trochlea [ 68 ] and might be related to the type of hardware used for fixation [ 66 , 68 ]. However, infection is uncommon and usually superficial [ 35 , 51 , 74 ].…”

Biomechanical stability of complex coronal plane fracture fixation of the capitellum

“…Jupiter 4 Anterior view of a group PLP specimen after cyclic loading and load to failure testing with the capitellum fragment's proximal displacement et al found that restoration of normal anatomy correlates with elbow joint function at the humeral distal frontal plane [12]. Thus, the basic surgical aim of this particular type of fracture's osteosynthesis is to restore anatomical integrity of the fragments, achieve lateral column stability, prevent interfragmentary rotation, and establish adequate support at the distal humerus [6].…”

“…Anteroposterior headless compression screws demonstrated favorable outcomes for the treatment of coronal plane fractures [8,15,17,23,28]. However, it is an appropriate technique for simple fractures, but inadequate for the management of Dubberley type B fractures, mostly including multiple fragments at the posterior part of the distal humerus and at the lateral capitellar area where the LCL adheres [6,33]. Mighell et al previously reported that if no adequate subchondral bone stock is available, iatrogenic fractures may also occur [17].…”