Fractures of the capitellum humeri and their associated injuries

Abstract

ObjectiveFractures of the capitellum are rare injuries but are often more complex and of a greater extent than assumed from conventional radiographs. Classification is usually based on their extension in relation to the trochlea the trochlea and on the number of fragments. Information on associated injuries is limited and only reported in small case series. The aim of this retrospective study was to report on our experience with capitellar fractures and their associated injuries.MethodsWe retrospectively reviewed all patients treated for fractures of the capitellum humeri at our institute between 2005 and 2017. Fractures were classified according to the Bryan–Morrey and the Dubberley classification and analyzed for their associated injuries depending on the fracture type using the chi-squared test.ResultsA total of 27 capitellar fractures were treated at our institute between 2005 and 2017. The median age of the patients was 57 years (range, 4–78) and they were all treated operatively. Associated injuries of the elbow were found in 12 cases (ten radial head fractures, two elbow dislocations, two tears of the radial collateral ligament). The injury mechanism was known for 26 patients (four fell on their outstretched arm, 19 suffered a direct blow to their elbow, two had a traffic accident).ConclusionThe incidence of radial head fractures is high in patients with capitellar fractures. Patients suffering a fracture of the capitellum humeri should be thoroughly examined for such associated injuries since a missed diagnosis can lead to poor outcomes.

Transverse capitellar shear fracture with interposed radial head fragment. A previously unclassified type of distal humeral fracture

“…Concomitant fractures, as in the case described, are reported within 21–37% [1,5] of capitellar fractures.…”

An Unusual Bryan and Morrey Type IV Capitellum Fracture with Posterolateral Rotational Instability: A Case Report

“…Adequate imaging of complex capitellum fractures is recommended for optimum surgical planning and fixation [ 3 , 10 ]. In this case, the CT images complemented plain radiographs in detecting the Type IV (B) fracture with a single, large posterolateral fragment containing the lateral epicondyle and a small fragment avulsed from the lateral supracondylar ridge attached to the LCL.…”

“…Transmission of axial forces from the radial head shearing the capitellum and direct lateral blow from spontaneous reduction of posterolaterally subluxed radial head following fall on an outstretched hand are suggested mechanisms of injury [ 2 ]. Isolated capitellum fractures are uncommon and tend to be associated with lateral epicondyle avulsion, lateral collateral ligament (LCL) avulsion, or radial head fractures [ 3 ]. Anatomical reduction and rigid fixation with at least two lag screws with preservation of posterior soft-tissue sleeve is advocated for such fractures [ 4 ].…”

Coronal Shear Fractures of the Distal Humerus: A Review of Diagnosis, Treatment, and Outcomes

“…Outcomes following these injuries are unclear, as there are multiple classification systems in use and the published literature consists of small case series without comparative groups. 3,5-18 Here, we undertake a comprehensive literature review of capitellum fractures of the distal humerus, in an attempt to summarize the existing body of evidence and propose areas of future study.…”