TITLE

Open Reduction and Internal Fixation of Capitellar Fractures with Headless Screws

AUTHOR(S)
Ruchelsman, David E.; Tejwani, Nirmal C.; Kwon, Young W.; Egol, Kenneth A.
PUB. DATE
June 2008
SOURCE
Journal of Bone & Joint Surgery, American Volume;Jun2008, Vol. 90-A Issue 6, p1321
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The outcome of operatively treated capitellar fractures has not been reported frequently. The purpose of the present study was to evaluate the clinical, radiographic, and functional outcomes following open reduction and internal fixation of capitellar fractures that were treated with a uniform surgical approach in order to further define the impact on the outcome of fracture type and concomitant lateral column osseous and/or ligamentous injuries. Methods: A retrospective evaluation of the upper extremity database at our institution identified sixteen skeletally mature patients (mean age, 40 ± 17 years) with a closed capitellar fracture. In all cases, an extensile lateral exposure and articular fixation with buried cannulated variable-pitch headless compression screws was performed at a mean of ten days after the injury. Clinical, radiographic, and elbow-specific outcomes, including the Mayo Elbow Performance Index, were evaluated at a mean of 27 ± 19 months postoperatively. Results: Six Type-I, two Type-III, and eight Type-IV fractures were identified with use of the Bryan and Morrey classification system. Four of five ipsilateral radial head fractures occurred in association with a Type-IV fracture. The lateral collateral ligament was intact in fifteen of the sixteen elbows. Metaphyseal comminution was observed in association with five fractures (including four Type-IV fractures and one Type-III fracture). Supplemental mini-fragment screws were used for four of eight Type-IV fractures and one of two Type-III fractures. All fractures healed, and no elbow had instability or weakness. Overall, the mean ulnohumeral motion was 123° (range, 70° to 150°). Fourteen of the sixteen patients achieved a functional arc of elbow motion, and all patients had full forearm rotation. The mean Mayo Elbow Performance Index score was 92 ± 10 points, with nine excellent results, six good results, and one fair result. Patients with a Type-IV fracture had a greater magnitude of flexion contracture (p = 0.04), reduced terminal flexion (p = 0.02), and a reduced net ulnohumeral arc (p = 0.01). An ipsilateral radial head fracture did not appear to affect ulnohumeral motion or the functional outcome. Conclusions: 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. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
32630639

 

Related Articles

  • Screw Fixation Compared with Suture-Button Fixation of Isolated Lisfranc Ligament Injuries. Panchbhavi, Vinod K.; Vallurupalli, Santaram; Jinping Yang; Andersen, Clark R. // Journal of Bone & Joint Surgery, American Volume;May2009, Vol. 91-A Issue 5, p1143 

    Background: A cannulated screw is currently used to reduce and stabilize diastasis at the Lisfranc joint. The screw requires removal and may break in situ. A suture button does not have these disadvantages, but it is not known if it can provide stability similar to that provided by a cannulated...

  • Metallic or bioabsorbable interference screw for graft fixation in anterior cruciate ligament (ACL) reconstruction? Papalia, Rocco; Vasta, Sebastiano; D'Adamio, Stefano; Giacalone, Antonino; Maffulli, Nicola; Denaro, Vincenzo // British Medical Bulletin;Mar2014, Vol. 109 Issue 1, p19 

    Background Approximately 100 000 anterior cruciate ligament (ACL) reconstructions are performed in the USA each year. Interference screw fixation is considered the standard for rigid fixation of the graft and provides higher fixation strength compared with other devices such as staples or...

  • A new hybrid fixation method in ACL reconstruction surgery. Madadi, Firooz; Sarmadi, Alireza; Kahlaee, Amir; Madadi, Firoozeh; Sadeghian, R.; Rahimi, F.; Mohammad Emami, T. // European Journal of Orthopaedic Surgery & Traumatology;Feb2010, Vol. 20 Issue 2, p137 

    There are several methods available for tibial side fixation of the reconstructed ACL ligament among which hamstring hybrid graft is a proper and widely accepted one. The present study compared biomechanical properties of the two methods for tibial side fixation of hamstring graft. Sixty-one...

  • Initial fixation strength of a hybrid technique for femoral ACL graft fixation. Weimann, Andre; Zantop, Thore; Herbort, Mirco; Strobel, Michael; Petersen, Wolf // Knee Surgery, Sports Traumatology, Arthroscopy;Nov2006, Vol. 14 Issue 11, p1122 

    Aperture fixation with interference screws matching the diameter of the tunnel is associated with the risk of graft laceration and graft rotation. A hybrid fixation technique (extracortical and aperture fixation) with undersized interference screws provides a higher fixation strength when...

  • Feasibility study on the potential of a spiral blade in osteoporotic distal femur fracture fixation. Wähnert, D.; Hofmann-Fliri, L.; Götzen, M.; Kösters, C.; Windolf, M.; Raschke, M. J. // Archives of Orthopaedic & Trauma Surgery;Dec2013, Vol. 133 Issue 12, p1675 

    Introduction: Osteoporotic fractures of the distal femur (primary as well as periprosthetic) are a growing problem in today’s trauma and orthopaedic surgery. Therefore, this feasibility study should identify the biomechanical potential of a (commercially available) spiral blade in the...

  • Cochrane in CORR: Intramedullary Nails for Extracapsular Hip Fractures in Adults (Review). Evaniew, Nathan; Bhandari, Mohit // Clinical Orthopaedics & Related Research;Mar2015, Vol. 473 Issue 3, p767 

    The article offers information on the orthopedic fixature Intramedullary Nails for extracapsular hip fracture. It mentions that extramedullary sliding hip screws were the standard of care from the 1950 to the 1990, but many surgeons now prefer intramedullary nails that interlock proximally in...

  • Mechanical behavior of screws in normal and osteoporotic bone. Seebeck, J.; Goldhahn, J.; Morlock, M. M.; Schneider, E. // Osteoporosis International;May2005 Supplement 2, Vol. 16, pS107 

    Fracture fixation in severe osteoporotic bone by means of implants that rely on screw anchorage is still a clinical problem. So far, a sufficiently accurate prediction of the holding capacity of screws as a function of local bone morphology has not been obtained. In this study the ultimate...

  • Revision Tibiotalar Arthrodesis. Easley, Mark E.; Montijo, Harvey E.; Wilson, Joseph B.; Fitch, Robert D.; Nunley, II, James A. // Journal of Bone & Joint Surgery, American Volume;Jun2008, Vol. 90-A Issue 6, p1212 

    Background: Contemporary recommendations for primary and revision ankle arthrodesis favor internal compression techniques involving the use of screw and/or plate fixation. While tibiotalocalcaneal arthrodesis with internal fixation may be a suitable method of salvage for the treatment of a...

  • The Effect of Suture-Button Fixation on Simulated Syndesmotic Malreduction: A Cadaveric Study. Westermann, Robert W.; Rungprai, Chamnanni; Goetz, Jessica E.; Femino, John; Amendola, Annunziato; Phisitkul, Phinit // Journal of Bone & Joint Surgery, American Volume;10/15/2014, Vol. 96 Issue 20, p1732 

    Background: The accuracy of reduction of distal tibiofibular syndesmosis disruptions has been associated with the clinical outcome. Suture-button fixation of the syndesmosis is a dynamic alternative mode of fixation. We hypothesized that with deliberate clamp-induced malreduction, suture-button...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics