Outcome of surgical treatment of type IV capitellum frac

• Published in: Chinese journal of traumatology 2012-08, Vol.15 (4), p.201-205
• Main Authors: Singh Ajay Pal, Dhammi Ish Kumar, Garg Vipul, Singh Arun Pal
• Format: Article
• Language: English
• ISSN: 1008-1275

【Abstract】 Objective: Fractures of the capitellum and trochlea constitute less than 1% of all elbow fractures and a shear fracture involving the capitellum and extending medially into most of the trochlea is rarely reported. Type IV capitellum fracture is still controversial in regard to its ra-diographic appearance, surgical approach and osteosynthesis. We report 10 cases of type IV capitellum fracture with a view to elucidating its clinical features and treatment outcome. Methods: We treated 10 patients of type IV capitellum fracture with a mean age of 32 years. A uniform surgical approach and postoperative rehabilitation were followed. Results: Nine patients presented to us after a mean of 4 days of injury and one patient was nonunion after 6 months of injury who had been treated conservatively by a bone setter. Double arc sign was absent in 6 cases. Intraopera-tively 6 capitellotrochlear fragments were devoid of soft Chin J Traumatol 2012;15(4):201-205 DOI: 10.3760/cma.j.issn.1008-1275.2012.04.002 Punjab Civil Medical Services-I Mukerian, Punjab, In-dia (Singh AP) Department of Orthopaedics, UCMS & GTB Hospital, Delhi, India (Dhammi IK and Garg V) Swami Premanand Hospital, Mukerian, Punjab, India (Singh AP) *Corresponding author: Tel: [phone], Email: [e-mail] C oronal shear fractures of distal end of humeral articular surface involve the capitellum and trochlea. These fractures are difficult to assess accurately on plain radiographs and the limited amount of subchondral bone available for stable internal fixation makes the operative treatment equally difficult. 1 Joint stiffness, instability and osteoarthrosis are complications resulting from treatment failures. 2 The major classification systems are proposed by Bryan and Dubberley et al. 3,4 Type IV fracture is a fracture involving the capitellum and extends to more than lateral half of the trochlea. 1 We report an analysis of ten cases of type IV capi-tissue attachments. By Mayo Elbow Performance Score evaluation, 7 patients got excellent, 2 good and 1 fair results. One patient with associated elbow dislocation developed heterotopic ossification. There was no case of avascular necrosis, osteoarthrosis or fixation failures. Conclusions: Type IV capitellum fractures are rare and belong to complex articular injuries. A good functional out-come can only be achieved with open reduction and stable internal fixation followed by early mobilization. Preopera-tive radiographic assessment and co