Fractures of the Capitellum and Trochlea

Guitton, Thierry G.; Doornberg, Job N.; Raaymakers, Ernst L. F. B.; Ring, David; Kloen, Peter
February 2009
Journal of Bone & Joint Surgery, American Volume;Feb2009, Vol. 91-A Issue 2, p390
Academic Journal
Background: Recent work has established that apparently isolated fractures of the capitellum are often more complex and involve the lateral epicondyle, trochlea, and posterior aspect of the distal part of the humerus. We assessed the experience with operative stabilization of fractures of the capitellum and trochlea at one level-I trauma center over a twenty-eight-year period. Methods: Thirty classifiable partial articular fractures involving the capitellum and trochlea were included in the study. Twenty-seven patients were followed for a minimum of twelve months, and fourteen patients returned for long-term follow- up at a median of seventeen years. The early and long-term results were evaluated according to the Broberg and Morrey Functional Rating Index. The long-term results were also evaluated according to the Mayo Elbow Performance Index (MEPI), the American Shoulder and Elbow Surgeons (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: Eighteen patients (67%) had one or more subsequent surgical procedures, and eight of these patients had the procedure to address surgical complications. Five of the eight patients with complications and ten additional patients underwent routine removal of implants; these fifteen patients included twelve of the fourteen patients in the long-term cohort. In addition to the fracture of the distal part of the humerus, four patients had a dislocation of the elbow; three, a fracture of the olecranon or the proximal part of the ulna; and two, a fracture of the radial head. The median arc of flexion improved from 106° at the time of early follow-up to 119° at the time of long-term follow-up (p < 0.05). In the group of fourteen patients with long- term follow-up, the median Broberg and Morrey score was 93 points at the time of early follow-up and 95 points at the time of late follow-up. The functional results were worse for patients with a Type-3 fracture, as classified with the system of Dubberley et al., than they were for those with a Type-I fracture. The fourteen patients with long-term follow-up had a median MEPI of 98 points, a median ASES score of 88 points, and a median DASH score of 8 points; nine of the fourteen patients had radiographic signs of arthrosis. Conclusions: The vast majority of what appear to be capitellar fractures are actually complex fractures of the articular surface involving both the capitellum and the trochlea. More complex fractures have worse functional results; however, the functional results of operative treatment seem to be durable over time. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Complication Rates Following Open Reduction and Internal Fixation of Ankle Fractures. SooHoo, Nelson F.; Krenek, Lucie; Eagan, Michael J.; Gurbani, Barkha; Ko, Clifford Y.; Zingmond, David S. // Journal of Bone & Joint Surgery, American Volume;May2009, Vol. 91-A Issue 5, p1042 

    Background: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. The purpose of the present investigation was to examine the risks of complications after open reduction and internal fixation of ankle fractures in a large population-based study. Methods: With use of...

  • Open Reduction and Internal Fixation of Capitellar Fractures with Headless Screws. Ruchelsman, David E.; Tejwani, Nirmal C.; Kwon, Young W.; Egol, Kenneth A. // Journal of Bone & Joint Surgery, American Volume;Mar2009 Supplement, Vol. 91-A, p38 

    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...

  • Effect of an Unrepaired Fracture of the Ulnar Styloid Base on Outcome After Plate-and-Screw Fixation of a Distal Radial Fracture. Souer, J. Sebastiaan; Ring, David; Matschke, Stefan; Audige, Laurent; Marent-Huber, Marta; Jupiter, Jesse B. // Journal of Bone & Joint Surgery, American Volume;Apr2009, Vol. 91-A Issue 4, p830 

    Background: The impact of an unrepaired fracture of the ulnar styloid base on recovery after internal fixation of a fracture of the distal part of the radius is uncertain. We evaluated a series of patients with an internally fixed fracture of the distal part of the radius to test the hypothesis...

  • Thoracolumbar Burst Fractures Treated with Posterior Decompression and Pedicle Screw Instrumentation Supplemented with Balloon-Assisted Vertebroplasty and Calcium Phosphate Reconstruction. Marco, Rex A. W.; Kushwaha, Vivek P. // Journal of Bone & Joint Surgery, American Volume;Jan2009, Vol. 91-A Issue 1, p20 

    Background: The treatment of unstable thoracolumbar burst fractures with short-segment posterior spinal instrumentation without anterior column reconstruction is associated with a high rate of screw breakage and progressive loss of reduction. The purpose of the present study was to evaluate the...

  • Open Reduction and Internal Fixation Compared with Circular Fixator Application for Bicondylar Tibial Plateau Fractures. Hall, Jeremy A.; Beuerlein, Murray J.; McKee, Michael D. // Journal of Bone & Joint Surgery, American Volume;Mar2009 Supplement, Vol. 91-A, p74 

    BACKGROUND: Standard open reduction and internal fixation techniques have been successful in restoring osseous alignment for bicondylar tibial plateau fractures; however, surgical morbidity, especially soft-tissue infection and wound necrosis, has been reported frequently. For this reason,...

  • Management of Acute Distal Humeral Fractures in Patients with Rheumatoid Arthritis. Jost, Bernhard; Adams, Robert A.; Morrey, Bernard F. // Journal of Bone & Joint Surgery, American Volume;Oct2008, Vol. 90-A Issue 10, p2197 

    Background: The best surgical treatment for a patient with rheumatoid arthritis and an acute distal humeral fracture is not well established. Because of the distorted anatomy of the arthritic elbow joint and the adjacent osteoporotic bone, total elbow arthroplasty may be favored over open...

  • High-Tension Double-Row Footprint Repair Compared with Reduced-Tension Single-Row Repair for Massive Rotator Cuff Tears. Domb, Benjamin G.; Glousman, Ronald E.; Brooks, Adam; Hansen, Matthew; Lee, Thay Q.; Neal S. ElAttrache // Journal of Bone & Joint Surgery, American Volume;Nov2008 Supplement 4, Vol. 90-A, p35 

    The article reports on the results of research which was conducted in an effort to compare the biomechanical behavior of high tension double row repair compared with reduced tension single row repair in the treatment of massive rotator cuff tears. A discussion of the challenges that a massive...

  • Function Plateaus by One Year in Patients With Surgically Treated Displaced Midshaft Clavicle Fractures. Schemitsch, Laura; Schemitsch, Emil; Veillette, Christian; Zdero, Rad; McKee, Michael // Clinical Orthopaedics & Related Research;Dec2011, Vol. 469 Issue 12, p3351 

    Background: Based on short-term (1 year or less) followup, primary fixation of displaced midshaft clavicle fractures reportedly results in better function compared with that reported for nonoperative methods. Whether better function persists beyond 1 year is unclear. Questions/purposes: For...

  • DISTRACTION HISTOGENESIS OVER INTRAMEDULLARY NAIL. A. R., Sulaiman; K. M., Liau; I., Munajat // Malaysian Journal of Medical Sciences;Jan2006 Supplement, Vol. 13, p63 

    PURPOSE : Distraction histiogenesis using conventional method either ilizarov ring fixator or unilateral external fixator requires an estimated duration of 30 days in children and 40 days in adult for one cm lengthening. Distraction over intramedullary nail is another alternative method with the...


Read the Article


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

Try another library?
Sign out of this library

Other Topics