Outcomes of Concomitant Fractures of the Radial Head and Capitellum: The “Kissing Lesion”

Claessen, Femke M.A.P.; Kachooei, Amir Reza; Kolovich, Gregory P.; Mudgal, Chaitanya S.

doi:10.1055/s-0036-1585430

Cited by 12 publications

(9 citation statements)

References 23 publications

(39 reference statements)

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“…The choice of surgical approaches is usually based on the fracture type and complexity, comfort of the orthopedic surgeon, and protection of the blood supply. For capitellar coronal fractures, the most commonly used approach is the lateral approach of elbow joint [6–16]. This approach was characterized by anatomic safety and simplicity, and adequate exposure of the radiocapitellar compartment.…”

Section: Discussionmentioning

confidence: 99%

“…The choice of surgical approach is one of the main areas of interest in the surgical management of fractures. For coronal shear fractures of capitellum, namely capitellar fractures without involvement of posterior aspect, most reports have used the lateral approach of elbow joint [6–16]. Though favorable outcomes have been reported, exposure range of the anterior aspect of the distal humerus is inadequate through this approach.…”

Section: Introductionmentioning

confidence: 99%

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

Hao

et al. 2019

J Orthop Surg Res

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Hao

et al. 2019

J Orthop Surg Res

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“…In this scenario, associated radial head fractures (or capitellar fractures) can be viewed as corresponding lesions on the opposite site of the joint, a phenomenon that has been termed “kissing lesion” on the elbow by Claessen et al. [ 6 ]. This term is also used for opposing osteochondral lesions in other regions such as the talotibial joint [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Fractures of the capitellum humeri and their associated injuries

et al. 2018

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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.

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“…Other authors have reported capitellum fractures with accompanying Essex-Lopresti variants, ulnar nerve palsies, or triceps avulsion fractures. 3,5,47,48 Caputo et al 49 presented a 10-patient series undergoing ORIF for Mason I or II radial head fractures who were found intraoperatively to have a cartilaginous fragment from the posterolateral capitellum interposed within their radial head fracture, a finding which had been previously described in rare case reports. Within the upper extremity, patients may have fractures of the scaphoid, distal radius, or proximal humerus.…”

Section: Associated Injuriesmentioning

confidence: 91%

“…40,41 Radial head Hotchkiss type 2 fractures have a higher association with concomitant capitellum fractures. 42 Reports of coexistent radial head fractures in operatively treated coronal shear distal humerus fractures include Ward and Nunley 41 (7/13, 54%), Rausch et al 10 (10/27, 37%), Heck et al 3 (3/15 patients, 20%), Watts et al 17 (19/79, 24%), Lopiz et al 13 (3/23, 13%), Ruchelsman et al 8 (5/16, 31%), and Dubberly et al 5 (3/27, 11.1%).…”

Section: Associated Injuriesmentioning

confidence: 99%

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

Fram

Seigerman

Ilyas

2019

Hand (New York, N,Y.)

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Fractures of the capitellum and trochlea are uncommon fractures of the elbow and can be challenging to treat due to their size, location, and articular nature. Because of their intra-articular nature and predilection toward displacement, these fractures are typically treated operatively. Furthermore, capitellum fractures have high rates of associated injuries, including radial head fractures or lateral collateral ligament injury in ~30% to 60% of patients. In addition to open reduction internal fixation, operative options include fragment excision, arthroscopic assisted reduction and fixation, and elbow arthroplasty. In this article, 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.

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Outcomes of Concomitant Fractures of the Radial Head and Capitellum: The “Kissing Lesion”

Cited by 12 publications

References 23 publications

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

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

Fractures of the capitellum humeri and their associated injuries

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

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