Technique for Internal Fixation of Capitellum and Lateral Trochlea Fractures

Abstract

Internal fixation for fractures of the humeral capitellum is a technically challenging procedure. Controversy exists regarding the optimal surgical approach and fixation technique. The benefit of stable fixation of the capitellum fragment is early mobilization. Our preferred technique involves anatomic reduction of the capitellar fragment and fixation with headless screws placed from anterior to posterior. When possible, the surgical exposure employed preserves the lateral ulnar collateral ligament (LUCL) and minimizes disruption of the soft tissues posterior to the capitellum.

Management of capitellum fractures by open reduction and internal fixation using Herbert screws

“…[24,32] Flexion was not limited much in our series compared with the normal arm (0°-135°), one patient with arthritis has loss of terminal 10° of flexion. Ten of our patients had an extension lag of 10°-25° but two of our patients had more extension loss due to implant impingement and arthritis.…”

“…[9,26,32] Fixation has been achieved using K-wires, cancellous screws [22,30] inserted from the posterior to anterior direction, and Herbert screws. [23][24][25][26] We used Herbert screws in our series, as fixation of the capitellar fracture using these screws has been found to be better than using Kwires or cancellous lag screws, [33] directed from the anterior to the posterior direction, as this eliminates the need for further soft-tissue dissection from the posterolateral aspect of condyle, besides achieving good fixation. Herbert screws are terminally threaded, providing fracture site compression through their variable thread pitch designs.…”

“…Many treatments and management methods have been advocated and include closed reduction and immobilization, [14] fracture fragment excision, [15] open reduction with or without internal fixation [16][17][18][19][20][21][22] using Kirschner wires (K-wires), cannulated screws or Herbert screws, [23][24][25][26] and prosthetic replacement. [27] Herbert screw provides some definite advantages over other methods of internal fixation.…”

Fractures of capitellum: a review of 14 cases treated by open reduction and internal fixation with Herbert screws

“…Injuries to the capitellum are usually a result of axial loading of the capitellum by forces transmitted through the radial head, the lateral trochlear ridge and the lateral half of the trochlea [3,4]. As the complex nature of capitellar fractures has become better appreciated, treatment options have evolved from closed reduction, immobilisation and fragment excision to a preference for open reduction and internal fixation with Kirschner wires (K-wires), cannulated cancellous screws and Herbert screws [5,6]. The Herbert screw offers distinct advantages over other modes of fixation.…”

Coronal shear fractures of distal humerus: Diagnostic and treatment protocols

“…Supplemental bone graft may be required in impacted fragments after their elevation [24][25][26] . Small articular fragments not amenable to fixation by 3.5 mm screws should be fixed by 2.7 mm miniscrews and buried in subchondral bone [3,15,23] (Figure 4).…”