Comprehensive Classification of the Capitellar Injury Concurrent with Radial Head Fracture.

BACKGROUND: Capitellar injury (CI) includes capitellar cartilage injury (CCI) and capitellar fracture (CF). A comprehensive classification of CI concurrent with radial head fracture (RHF) that can guide surgical strategy is lacking in the literature. Therefore, this study aimed to introduce a comprehensive classification of CI concurrent with RHF and investigate its value. METHODS: A total of 35 patients with CI concurrent with RHF confirmed by surgical exploration were retrospectively analyzed, includingmales in 19 cases and females in 16 cases. RHF was classified according to the Mason classification, and CI was classified into six types, including 3 types of CCI and CF, each based on the site and degrees of injuries (comprehensive classification method proposed in this study). The classification results were analyzed. Two radiologists were selected to independently classify the CI, and the inter- and intra-observer agreements were analyzed with kappa statistics. RESULTS: Mason Type I, II, III, and IV RHF accounted for 14.3%, 48.6%, 37.1%, and 0% of cases, respectively. Type I, II, III, IV, V, and VI CIs accounted for 22.9%, 34.3%, 25.7%, 11.4%, 2.9%, and 2.9% of cases, respectively. Therewas no obvious relationship between the CI and RHF types (p > 0.05). All Type I CIs underwent removal, 9 Type II CIs underwent microfracture repair, and 3 Type II CIs underwent removal. All Type III CIs underwent fixation, one Type IV CI underwent removal, and 3 Type IV CIs underwent fixation, one Type V CI underwent fixation, and one Type VI CI underwent arthroplasty. The inter- and intra-observer kappa coefficients were 0.830 ~ 0.905 and 0.805 ~ 0.892, respectively. At 12 months postoperatively, the elbow function evaluated by MEPS was 91, with an excellent and good rate of 97%. CONCLUSION: Different types of CI differ not only in pathology but also in treatment methods. The CI comprehensive classification put forth in this paper for the first time reflects different types of pathology well, with high consistency and repeatability, and can guide the selection of surgical methods, leading to satisfactory postoperative results.

Clinical outcomes of capitellar fractures with posterior comminution treated with Herbert screws combined with metacarpal locking plates.

BACKGROUND: The treatment of Dubberley type B capitellar fractures, which are frequently complicated, is widely debated. This study aimed to investigate the prognostic factors and clinical outcomes of Dubberley type B capitellar fractures treated with Herbert screws combined with posterior buttress plates. METHODS: Seven men and nine women (aged 30-68 years) with Dubberley type B capitellar fractures were operated on with Herbert screws combined with posterior buttress plates. The patients were classified into Dubberley types IB (seven), IIB (four), and IIIB (five). Complications and bone union were observed, and functional outcomes were evaluated by the Mayo Elbow Performance Index (MEPI). RESULTS: All patients were followed up for a mean period of 23.5 months (12-30 months). All fractures healed in 8-14 weeks (mean, 10.5 weeks). No cases of non-union, elbow instability, or avascular necrosis occurred. Degenerative arthritis occurred in 7 (44%) and heterotopic ossification in 11 (69%) patients. The median MEPI score was 92.5 (interquartile range, 85-100) points, with 11 reporting excellent, 3 good, and 2 fair outcomes. The MEPI scores of type IIIB fractures were significantly lower than those of types IB and IIB fractures, while the MEPI scores of type IB and IIB fractures did not differ significantly. CONCLUSIONS: Dubberley type IIIB capitellar fractures with multiple articular fragments have a poorer prognosis than type IB and IIB fractures. However, Herbert screw fixation combined with posterior metacarpal locking plates is feasible, providing satisfactory recovery of elbow joint function.

Arthroscopic-Assisted Fracture Fixation About the Elbow.

Arthroscopic-assisted fracture fixation can be used for some adult elbow fractures. In particular, for articular fractures of the anterior elbow (coronoid/capitellum), elbow arthroscopy can provide excellent visualization of fracture fragments using a less invasive surgical exposure. Meticulous adherence to safe techniques and utilization of specialized equipment can help maximize safety and facilitate reproducible surgical results.

Biomechanical comparison of biodegradable magnesium screws and titanium screws for operative stabilization of displaced capitellar fractures.

BACKGROUND: Displaced fractures of the humeral capitellum are commonly treated operatively and fixed by titanium screws (TSs) either directly or indirectly. In the case of direct transcartilaginous fixation, biodegradable screws with the ability to be countersunk can be favorable regarding implant impingement and cartilage destruction. Hence, the goal of this study was to biomechanically compare headless compression screws made from titanium with a biodegradable equivalent made from a magnesium alloy. METHODS: This biomechanical in vitro study was conducted on 13 pairs of fresh-frozen human cadaveric humeri, in which a standardized Bryan-Morrey type I fracture was fixed using 2 magnesium screws (MSs) or 2 TSs. First, construct stiffness was measured during 10 cycles of static loading between 10 and 50 N. Second, continuous loading was applied at 4 Hz between 10 and 50 N, increasing the maximum load every 10,000 cycles by 25 N until construct failure occurred. This was defined by fragment displacement >3 mm. RESULTS: Comparison of the 2 screw types showed no differences related to construct stiffness (0.50 ± 0.25 kN/mm in MS group and 0.47 ± 0.13 kN/mm in TS group, P = .701), failure cycle (43,944 ± 21,625 and 41,202 ± 16,457, respectively; P = .701), and load to failure (152 ± 53 N and 150 ± 42 N, respectively; P = .915). CONCLUSION: Biomechanical comparison showed that simple capitellar fractures are equally stabilized by headless compression screws made from titanium or a biodegradable magnesium alloy. Therefore, in view of the advantages of biodegradable implants for transcartilaginous fracture stabilization, their clinical application should be considered and evaluated.

Headless double-threaded compression screws plus microplate for capitellar fracture of Ring type Ⅱ / 中华创伤骨科杂志

Objective To investigate the clinical effects of headless double-threaded compression screws plus microplate for treatment of capitellar fracture of Ring type Ⅱ.Methods In the period from March 2015 to February 2018,12 capitellar fractures of Ring type Ⅱ were treated at Department of Upper limb Orthopedics,Zhengzhou Orthopaedics Hospital.There were 8 men and 4 women,aged from 25 to 57 years (average,35.4 years).There were 5 left and 7 right fractures.The fractures were exposed and reduced through the posterolateral elbow approach in 6 patients and through the lateral elbow approach in the other 6 ones.Fixation of all the fractures was conducted with headless double-threaded compression screws plus microplate.At the final follow-up,the elbow function was evaluated by the Mayo elbow performance score and the severity of traumatic arthritis by the Broberg & Morrey imaging criteria.Results All the patients were followed up for 9 to 36 months (average,23 months).The fracture healing time ranged from 9 to 12 weeks (average,10.6weeks).The final follow-ups revealed fine stability of the affected elbow joint in all the patients,and no loss of reduction,loosening or breakage of internal fixators or ischemic necrosis in any case.At the final follow-ups,the elbow inflection angles ranged from 90° to 130° (average,114.3°),the elbow extension angles from 0° to 20°(average,12.4°),the forearm pronation angles from 50° to 85° (average,70.5°) and the forearm supination angles from 45° to 80° (average,64.3°).The Mayo elbow performance scores at the final follow-up averaged 93.2points (from 85 to 100 points),yielding 8 excellent and 4 good cases.According to the Broberg & Morrey imaging criteria,10 patients showed no regressive change and 2 patients change by one grade.Conclusions A proper surgical approach should be chosen according to the preoperative imaging findings.The fracture of articular surface can be firmly fixated by head-less double-threaded compression screws and the integrity of the distal lateral column of the humerus can be restored with a microplate to achieve a strong biomechanical fixation.Fine clinical outcomes can be obtained by early functional exercise.

Anterolateral approach for an unusual pediatric capitellar fracture: a case report and review of the literature.

A 9-year-old boy sustained a previously unreported salter-Harris III coronal plane fracture of the anterior capitellum after a 20-foot fall from a tree. the fracture was diagnosed on x-ray and an MrI confirmed the fracture pattern. During surgical treatment, an anterolateral approach to the elbow allowed direct visualization of the fracture fragment, anatomic reduction, and fixation with a bioabsorbable pin. At one year follow-up the patient's range of motion and function was symmetric to the contralateral extremity. this paper reviews the literature regarding the epidemiology, classification, and management of the rare pediatric capitellar fracture.

Operative Treatment of Capitellar Fractures Associated with/without Other Injury Around the Elbow

PURPOSE: We wanted to assess the radiological and clinical results and the prognostic factors after an operation for capitellar fractures associated with/without other injury around the elbow. MATERIALS AND METHODS: Among the 25 patients (mean age: 49 years-old) who underwent open reduction and internal fixation for capitellar fractures, there were nineteen type 1 fractures and six type 3 fractures. The mean follow up period was 14.8 months. We assessed the factors affecting the radiological and functional results, such as the fracture pattern, the patient age and the surgical approaches. RESULTS: In 24 of 25 patients, bony union was achieved at postoperative 1 year. There were eighteen excellent, four good, two fair and one poor functional results according to the Broberg and Morrey elbow score. The most common type was type 1 and the most common associated injury was lateral condylar fracture. The patients with type 1 fracture rather than the patients with type 3 fracture and the patients who had an extraarticular associated fracture rather than an intraarticular associated fracture had better clinical outcomes. CONCLUSION: 22 (88%) of the patients were satisfied at the result. The type of capitellar fracture and an associated intraarticular elbow fracture were shown to be important prognostic factors in this study.

Internal Fixation of Capitellar Fractures Using Herbert Screws: A Report of Three Cases / 대한정형외과학회잡지

Capitellar fracture was first described by Hahn in 1853. It is rare, espically in children, and has been occurred 0.5% to 1% of incidence of all elbow injuries. Factures of the capitellum can involve a significant portion of the articular surfaces. It is desirable to reduce and internally fix the capitellar fragment, if possible, because this restores the artucular surface and augment joint stability. Three patients with displaced fractures of the capitellum(capitulum humeri) were treated by open reduction and internal fixation using Herbert screws, which stabilized the joint, allowed anatomical reduction, and gave rigid fixation. Postoperatively, early motion of the joint was allowed. All fractures were united without evidence of avascular necrosis and final follow-up was excellent.