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

Abstract

Fourteen patients with displaced fractures of the humeral capitellum were treated by open reduction and internal fixation of the capitellar fragments with Herbert screws. As per Bryan and Morrey classification, there were seven type I fractures, one type II fracture, three type III fractures, and three non-unions. Patient outcomes were evaluated using the Mayo elbow performance score. The follow-up period ranged from three to seven years (mean 4.8 years). All patients had a stable, pain-free elbow with good range of motion at follow-up. There was no evidence of avascular necrosis or degenerative change.

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

“…[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.…”

“…It achieves better fracture site compression, provides stable fixation without damaging the articular cartilage, allowing early joint motion and less or no need for second stage hardware removal. [23,28] We present a retrospective study of 15 cases of capitellar fractures treated using Herbert screw fixation over a period of 4 years with a mean follow-up of 3.6 years. The purpose of this present study was to perform an objective and subjective evaluation with functional outcome of patients with capitellar fractures that were treated with internal fixation by inserting Herbert screws in an anterior-to-posterior direction after open reduction via an extensile lateral approach.…”

“…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.…”

Comment on Singh et al.: Fractures of capitellum: a review of 14 cases treated by open reduction and internal fixation with Herbert screws

“…

We read with deep interest the article by Singh et al [1]. We thank the authors for sharing with us such experience with these rare injuries.

Since the capitellum injury is an uncommon fracture, the described technique left certain queries unanswered for the less experienced user.

…”

“…We read with deep interest the article by Singh et al [1]. We thank the authors for sharing with us such experience with these rare injuries.…”