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Capitellum Fracture

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Other Names

  • Elbow Fracture
  • Capitellum fractures
  • Capitellar Fracture

Background

Epidemiology

  • Uncommon
  • Represents 1% of all elbow fractures[1]
  • 4-6% of all distal humerus fractures[2]

Pathophysiology

  • Typically involves fall on outstretched hand, often from standing
  • Elbow is semi-flexed
  • Axial transmitted to capitellum by the radial head

Associated Conditions


Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features

  • General: Physical Exam Forearm
  • History
    • History of trauma
    • Patient self reports pain, swelling, deformity
  • Physical
    • Ecchymosis, swelling
    • Tenderness
    • Loss of range of motion

Evaluation

  • Radiographs
    • 3 view elbow standard
    • Best viewed laterally
    • May be missed if fracture fragment is small
    • Osteochondral lesions may be missed if fragment is occult
    • McKee's 'double arc sign' two seperately visible arcs represent displaced capitellum, trochlea[3]
  • CT
    • Can be helpful to clarify fracture pattern, classification

Classification

Bryan and Morrey Classification (with McKee modification)

  • Type I: Large osseous piece of the capitellum involved in coronal plane, may involve trochlea
  • Type II: Kocher-Lorenz fracture, shear fracture of articular cartilage, articular cartilage separation with very little subchondral bone attached
  • Type III: Broberg-Morrey fracture, severe comminution
  • Type IV: McKee modification, coronal shear fracture that includes the capitellum and trochlea

Management

  • In general, displaced fractures lead to poor clinical outcomes if left untreated, most often requiring surgery

Nonoperative

  • Indications
    • Nondisplaced type I, II with <2 mm displacement
  • Splint: Posterior Long Arm Splint for 2-3 weeks
  • Transition to pre-fab for early range of motion exercises

Operative

  • Indications
    • Displaced type I, II, III fractures >2 mm
    • Type IV fractures
  • Technique
    • ORIF (can be open or arthroscopic)
    • Fragment excision
    • Arthroplasty

Return to Play

  • Highly variable
  • Discretion of orthopedic surgeon

Complications


See Also


References


  1. Bryan RS, Morrey BF. Fractures of the distal humerus. Philadelphia: WB Saunders; 1985.
  2. Khalili M, Wong RJ. Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net. Dig Dis Sci. 2018 Dec;63(12):3250-3252. doi: 10.1007/s10620-018-5316-9.
  3. Coronal Shear Fractures of the Distal End of the Humerus*. (1996) The Journal of Bone and Joint Surgery-american Volume. 78 (1): 49. doi:10.2106/00004623-199601000-00007
Created by:
John Kiel on 18 June 2019 01:12:34
Authors:
Last edited:
11 November 2020 14:28:20
Categories:
Trauma | Elbow | Upper Extremity | Fractures | Acute