Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws

Mighell, Mark A.; Virani, Nazeem A.; Shannon, Robert; Echols, Eddy L.; Badman, Brian L.; Keating, Christopher J.

doi:10.1016/j.jse.2009.05.012

Cited by 98 publications

(95 citation statements)

References 31 publications

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“…The concepts stated in recent reviews in the treatment of distal humerus fractures that emphasize the fact that dual plate fixation, with placement of a separate strong plate on each column, is indicated for all adult fractures involving both columns of the distal part of the humerus [3,4], is probably based on series including many different fracture types. It is our belief that, as it has happened with coronal shear fractures of the distal humerus, of which there are now multiple publications demonstrating that they need a different approach and fixation than the rest of distal humerus fractures [10,18,19], our series shows that transverse supracondylar fractures and nonunions in adults should not be systematically treated with double plating, and double tension band fixation can be a reliable, easy and cost effective technique for the management of these particular lesions and should remain an option to be considered when planning the stabilization of these fractures and nonunions.…”

Section: Discussionmentioning

confidence: 99%

Double tension band osteosynthesis in transverse supracondylar distal humerus fractures and nonunions

Allende

Gutiérrez

Savoy

et al. 2012

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the objective and subjective results achieved after double tension band fixation in transverse extra-articular intracapsular supracondylar distal humerus fractures and nonunions in adults. Methods Nine patients presenting six fractures and three nonunions of the distal humerus, treated with double tension band wiring between 1998 and 2011, were retrospectively evaluated. Two fractures were type A2 and four type A3, and the nonunions were oligotrophic; all nine lesions had a supracondylar intracapsular transverse orientation, that passed through the olecranon fossa, in a direction parallel to the joint line, and they compromised both columns of the distal humerus. Patient's age averaged 70 years (range, 56-82). Results Follow-up averaged 24.6 months (range, 12-53). All fractures and nonunions united; there were no infections, elbow stiffness or heterotopic bone formations. DASH score at final follow-up averaged 14.2 points (range, 4-22). The analog scale of pain averaged 1.1 points (range, 0-3). Elbow range of motion averaged 100°(range, 100-120°). Flexion averaged 123°(range, 115-130°) and elbow extension loss averaged 15.5°(range, 10-25°).Conclusions The results achieved with double tension band fixation in transverse extra-articular intracapsular supracondylar distal humerus fractures and nonunions are comparable to the results that can be expected when using other available fixation methods; this technique is faster, less demanding and cheaper, and surgeons should have it in mind when leading with these particular types of distal humerus fractures and nonunions.

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Section: Discussionmentioning

confidence: 99%

Double tension band osteosynthesis in transverse supracondylar distal humerus fractures and nonunions

Allende

Gutiérrez

Savoy

et al. 2012

International Orthopaedics (SICOT)

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“…The osteotomy may be repaired with tension band construct or cannulated screw system. In studies published till now the differences between the outcomes between extended lateral and the posterior midline approach are negligible [3,9,19,20] .…”

Section: Anterolateral Approachmentioning

confidence: 96%

“…Usually the associated injuries are of lateral collateral ligament, trochlea, epicondyle, condylar and elbow dislocation [3][4][5][6][7][8] . Lateral collateral ligament injury is seen in 40% and radial head fracture is reported in 30% of the patients [2,8,9] .…”

Section: Relevant Anatomymentioning

confidence: 99%

“…This is most commonly used approach for isolated capitellar and Type Ⅳ capitellum farctures [1,3,6,9,15,16] . Under regional/general anaesthesia the injured elbow is assessed clinically for ligamentous stability.…”

Section: Extensile Lateral Approachmentioning

confidence: 99%

“…Closed reduction, immobilisation and fragment excision are known to be associated with poor outcomes [7,8] . Failure of fixation or non-anatomic reduction leads to articular incongruity, posttraumatic arthrosis, stiffness and potential ulnohumeral instability [8][9][10] . The intraarticular and complex nature of these fractures makes optimal surgical exposure and implants debatable.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Coronal shear fractures of distal humerus: Diagnostic and treatment protocols

Singh¹,

Singh²

2015

WJO

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Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy and imaging advancements, the complex nature of these fractures is well appreciated now. These fractures involve metaphysealcomminution of lateral column and associated intraarticular injuries are common. Previously, closed reduction and excision were the accepted treatment but now preference is for open reduction and internal fixation with an aim to provide stable and congruent joint with early range of motion of joint. Various approaches including extensile lateral, anterolateral and posterior approaches have been described depending on the fracture pattern and complexity. Good to excellent outcome have been reported with internal fixations and poor results are noted in articular comminution with associated articular injuries. Various implants including headleass compression screws, minifragment screws, bioabsorbable implants and column plating are advocated for reconstruction of these complex fractures. Inspite of articular fragments being free of soft tissue attachments the rate of osteonecrosis and osteoarthritis is reported very less after internal fixation. This article summarizes the diagnostic and treatment strategies for these rare fractures and recommendations for management.

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Distal Humerus Fractures

Sánchez-Sotelo

2014

Essentials in Elbow Surgery

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Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws

Cited by 98 publications

References 31 publications

Double tension band osteosynthesis in transverse supracondylar distal humerus fractures and nonunions

Double tension band osteosynthesis in transverse supracondylar distal humerus fractures and nonunions

Coronal shear fractures of distal humerus: Diagnostic and treatment protocols

Distal Humerus Fractures

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