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

Abstract

BACKGROUND: Capitellar fractures are rare elbow injuries and can cause severe limitation of function if not properly managed. Numerous treatments have evolved, from closed reduction and cast immobilization to open reduction and internal fixation (ORIF), so as to achieve a stable joint that allows early mobilization. We determined the functional outcomes of treating these fractures with ORIF using Herbert screws via an extensile lateral approach.

Capitellum fractures: Treatment with headless screws and outcomes

“…On the other hand, some authors did not observe any AVN in their patients. [13,15,[20][21][22][23] In our study, AVN developed in three patients (14%). This result is consistent with the current literature.…”

“…Due to the chondral damage during this injury, these patients are at risk of developing secondary elbow osteoarthrosis. [5,10] In terms of degenerative joint disease or arthrosis, Mighell et al [12] reported arthrosis in 28% of their patients, while Sultan et al [13] observed arthrosis only in one patient (7%) from a series of 15 patients who had type I and type IV fractures, according to Bryan and Morrey. All patients in Mahirogullari et al's [15] series had type I fractures, and the authors did not encounter arthrosis in any of their patients.…”

“…[11] It is known that there is a female dominance in capitellum fractures. [12][13][14] In Mighell et al's [12] series of 18 patients, 16 of the patients were females and two were males. In other studies, 60 to 100% female dominance in the capitellum fractures has been reported.…”

“…Mahirogullari et al [15] and Dubberley et al [19] stated that they placed the screw from the posterior toward the anterior. Sultan et al [13] reported that they preferred to insert the screws from the anterior to the posterior, thus providing a good compression in the fracture line without the need for a soft tissue dissection beyond the posterolateral of the condyle. Mighell et al [12] argued that they preferred to place the screws from the anterior to the posterior, thus preserving the posterior flap and not disturbing the circulation of the capitellum.…”

“…When the literature was reviewed in this respect, no clinically significant heterotopic ossification was reported. [5] Similarly, Sultan et al [13] and Mahirogullari et al [15] reported that they did not encounter heterotopic ossification and that they did not apply prophylaxis in any patient. On the other hand, Mighell et al [12] reported a rate of 17% of heterotopic ossification in their 18-case series.…”