The Treatment and Functional Outcome of Type IV Coronal Shear Fractures of the Distal Humerus: A Retrospective Review of Five Cases

Abstract

Recognition of this particular type of injury, prompt treatment with anatomic reduction and internal fixation, and early rehabilitation can lead to excellent functional outcomes.

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

“…These findings support those reported by Stamatis and Paxinos, in which their only patient with AVN also had an excellent BM score. 30 Although instability can be an inherent complication associated with this injury, it was not seen in the present series. 14 Finally, we did not see any incidence of nonunion, which further corroborates the other studies presently reviewed.…”

“…Release of the Similar to other studies, several patients in the present series developed AVN (17%), degenerative joint disease (28%), or heterotopic ossification (17%). 14,18,27,30 According to our statistical analysis, the presence of AVN did not prevent an excellent BM score, and 2 of our patients had good to excellent results despite the presence of AVN. These findings support those reported by Stamatis and Paxinos, in which their only patient with AVN also had an excellent BM score.…”

“…14,18,24,26,27,30 With the exception of Ruchelsman et al, all of the above studies are limited by the small patient size ranging from 4 to 6 patients. 27 Our study is unique in that it has a larger sample size than any other previously reported in the literature, allowing us to break our patients into subgroups for statistical comparison.…”

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

“…We did not find double arc signs in any of the three patients of capitellum and trochlear fracture with comminuted lateral condyle fracture. This sign may not be radiographically apparent in all type IV fractures because of the presence of an internally rotated capitellum and trochlea fragment [6,9]. Radiographs must be carefully assessed for the presence of medial trochlear extension, metaphyseal comminution, and associated radial head and/ or neck pathology.…”

“…Fixation with compression screws irritates the cartilage of the radial head, as the metal head protrudes from the articular surface. Cannulated screws introduced posteriorly through the humerus into the capitellum avoid this problem [9]. However, if the osteochondral fragment is small the screw may split it.…”