Reconstruction of a Bryan and Morrey type I capitellar fracture in a sawbone model with four different fixation devices: An experimental study

Koslowsky, Thomas C.; Zilleken, Christian; Dargel, Jens; Thelen, Ulrich; Burkhart, Klaus J.; Heck, Steffen; Skouras, Emmanouil

doi:10.1016/j.injury.2011.12.004

Cited by 12 publications

(9 citation statements)

References 17 publications

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“…Metallic screw fixation was the most commonly used technique. Biomechanical studies have demonstrated that metallic screws can provide favourable stability for constructed capitellum fractures [ 14 , 15 ]. Although several different types of screw (cannulated, cortical lag, cancellous, headless, and Herbert screws) were used, no direct comparison between the different screws could be made due to the heterogeneous reporting of clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

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

Hao

et al. 2018

BMC Musculoskelet Disord

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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.

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Section: Discussionmentioning

confidence: 99%

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

Hao

et al. 2018

BMC Musculoskelet Disord

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“…The main internal fixation methods are headless compression screw, AO cortical screw, Kirschner wire, anti-slide plate, suture, and so on. Klslowsky reported that the strength of fine-threaded wires, Herbert screws, and AO screws fixation for Hahn-Steinthal fracture were better than Kirschner wires in an experimental biomechanical study 14 . Poynton considered that Herbert screw was better than Kirschner wire in the treatment of capitellum frature because compression fixation of fracture allow early postoperative movement, with little damage to articular cartilage and no need to remove implants when buried under the articular surface 15 .…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Comminuted Coronal Shear Fracture of Distal Humerus

Teng

Zhong

2020

Orthopaedic Surgery

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Objective: To investigate the surgical approach, fixation, and clinical effect of comminuted coronal shear fracture of distal humerus. Methods: From March 2017 to February 2019, we had used open reduction and internal fixation to treat 19 cases of comminuted distal humeral coronal shear fracture. There were 8 males and 11 females, with an average age of 44.6 years (19-72 years). There were 10 cases on left side and 9 cases on right side. All cases were closed fractures. According to Dubberley's classification, there were six cases of type 1, six cases of type 2, and seven cases of type 3. The lateral Kocher approach, extended Kocher approach, extended Kocher approach combined with a medial incision and the olecranon osteotomy approach were used for exposure. Headless screw, Kirschner wire, and suture were used to fix the fractures. Two cases were fixed with hinged elbow fixators additionally. The follow-up was evaluated by Mayo Elbow Performance Score (MEPS). Results: All patients were followed up for an average of 17.1 months (range, 12 to 30 months). The average time of fracture union was 8.8 ± 1.9 weeks. There were three cases of degenerative osteoarthritis of elbow and one case of heterotopic ossification after operation. A total of 10 patients underwent removal of implants. At the last follow-up, the elbow flexion-extension arc was 130.5 ± 10.5. The forearm rotation arc was 167.4 ± 6.1. The MEPS was 85.8 ± 8.5, the results were classified as excellent in nine cases, good in eight, and fair in two. The excellent and good rate was 89.5%. The time of fracture union of type 1 was shorter than type 3 (P = 0.024), the elbow flexionextension arc of type 1 fracture was better than type 2 (P = 0.043) and type 3 (P = 0.012), the forearm rotation arc of type 1 fracture was better than type 3 (P = 0.006), the MEPS of type 1 fracture was better than type 2 (P = 0.009) and type 3 (P = 0.002). Conclusion: Open reduction and internal fixation with headless screw, Kirschner wire, and suture can be used for the treatment of comminuted distal humeral coronal shear fractures. The elbow joint function can be restored satisfactorily.

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“…Many types of internal fixation devices have been reported for reconstruction of capitellar fractures [22–25]. In a sawbone model biomechanical testing, Bryan and Morrey type I fractures were fixed with K-wires, Herbert screws, AO screws, and fine-threaded wires.…”

Section: Discussionmentioning

confidence: 99%

“…In a sawbone model biomechanical testing, Bryan and Morrey type I fractures were fixed with K-wires, Herbert screws, AO screws, and fine-threaded wires. The results showed that reconstructed fractures with screws were significantly more stable [25]. Herbert screws fixation has become popular for coronal shear fractures of the capitellum and good clinical results have been published because the advantages offered by these screws include excellent compression at the fracture fragments, stable fixation, and nonprominence of the implant intraarticularly [26].…”

Section: Discussionmentioning

confidence: 99%

Comparison of lateral approach versus anterolateral approach with Herbert screw fixation for isolated coronal shear fractures of humeral capitellum

Hao

et al. 2019

J Orthop Surg Res

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Background For coronal shear fractures of humeral capitellum, the lateral approach is the most commonly used surgical approach. However, exposure range of the anterior aspect of the distal humerus is inadequate. The anterolateral approach has also been adopted to overcome this disadvantage. However, this approach seems anatomically complex due to the risk of iatrogenic injury to the radial nerve. So far, the optimal approach for the treatment of capitellar shear fractures remains inconclusive. The purpose of this study is to prospectively review and compare the early clinical and radiographic outcomes of treated with open reduction and Herbert screw internal fixation through the lateral approach or the anterolateral approach. Methods Twenty-six patients with isolated capitellar shear fractures were enrolled from January 2013 to December 2017, and randomly assigned to lateral approach group or anterolateral approach group. All the fractures were treated with open reduction and Herbert screw internal fixation through lateral approach or anterolateral approach. Operation time, wound healing complication, elbow joint function, and radiographic evidence were evaluated and compared between two groups. Results The operation via the anterolateral approach took significantly shorter time than via lateral approach ( p < 0.05). There were no wound healing problems and infection for both groups. One patient from anterolateral approach group sustained incomplete posterior interosseous nerve palsy, which recovered completely in 4 weeks without residual compromise. All fractures healed well in their normal anatomic position as seen on radiographs. At the final follow-up, no significant difference was found between two groups with respect to the ROM in supination-pronation, ROM in pronation-supination, loss of flexion-extension motion, or loss of pronation-supination motion ( p > 0.05). There is no significant difference with respect to MEPI score of elbow joint between two groups ( p > 0.05). Conclusion Based on our findings, both lateral approach and anterolateral approach with Herbert screw internal fixation are suitable for coronal shear fractures of capitellum with satisfactory early outcomes. Compared with the lateral approach, the anterolateral approach made the surgical procedure easier and time saving in current series. When the medial aspect of the trochlea is involved for capitellar coronal fractures, the anterolateral lateral approach should be preferred.

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Reconstruction of a Bryan and Morrey type I capitellar fracture in a sawbone model with four different fixation devices: An experimental study

Cited by 12 publications

References 17 publications

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

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

Surgical Treatment of Comminuted Coronal Shear Fracture of Distal Humerus

Comparison of lateral approach versus anterolateral approach with Herbert screw fixation for isolated coronal shear fractures of humeral capitellum

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