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

Abstract

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.

Functional Outcome of a Coronal Shear Fracture of the Capitellum Managed by Herbert Screw Fixation Using the Anterolateral Surgical Approach

“…However, the disadvantage of the lateral approach is a lack of sufficient exposure of the capitulum and trochlea, and this hinders the visibility of the fracture site for anatomic reduction. Also, inserting the screws perpendicular to the fracture site by this approach is difficult (particularly for fractures of the capitellum extending to the trochlea) [2,[10][11]13]. Dubberley et al recommended that sectioning of the lateral collateral ligament or a flexor-pronator split is needed if the medial aspect of the trochlea cannot be exposed adequately or if the anatomic reduction is not ensured by the lateral approach [5].…”

“…Dubberley et al recommended that sectioning of the lateral collateral ligament or a flexor-pronator split is needed if the medial aspect of the trochlea cannot be exposed adequately or if the anatomic reduction is not ensured by the lateral approach [5]. The anterolateral approach has the advantage that it can expose the capitellum and trochlea clearly, which makes it possible to reduce the fracture anatomically and achieve stable fixation by screw placement perpendicular to the fracture line [2,[10][11]13]. Besides, the release of the common extensor origin is avoided, preventing postoperative extensor lag.…”

“…The anterolateral approach of the elbow joint has been adapted in many studies to treat these capitellar fractures. The anterolateral surgical approach provides adequate anterior exposure of the elbow joint as compared to the lateral approach [10][11].…”

Neglected Comminuted Fracture of the Capitellum

“…For coronal-shear capitellar fractures, most surgeons use the lateral approach for exposure of the elbow. The drawback of this approach is limited exposure of the medial articular extension and trochlea, making it difficult to recognize the actual fracture anatomy [4]. In our case, as the fracture line was extending medially to the trochlea, the anterolateral surgical approach was used as it provides adequate anterior exposure of the elbow joint.…”

Clinical Efficacy of a Micro-locking Plate Vertical or Parallel Technique for Treatment of Dubberley B-type Capitellar Fractures

“…The mean Mayo Elbow Performance Index score was 92 ± 10 points, with nine excellent results, six good results, and one fair result. A randomized controlled trial conducted by Tengbo Yu [13]who compared the Herbert screw xation between the lateral approach and anterolateral approach in 26 patients and demonstrated that both lateral approach and anterolateral approach with Herbert screw internal xation are suitable for coronal shear fractures of capitellum with satisfactory early outcomes. However, screw internal xation is not suitable in cases of Dubberley B-type fractures involving incomplete capitulum fracture of the humerus behind the lateral condyle [7].…”