Abstract
Capitellar and trochlear fractures are infrequent partial articular fractures of the distal humerus. These types of fractures include a very wide pattern of lesions ranging from relatively simple lesions that interest only the capitellum, with good subchondral bone, that can be treated with screw fixation through anatomical approaches, to very complex fractures with extensive fragmentation and comminution that require extensile approaches and that can be treated with plates, bone chips, external fixator, or even prosthetic replacement. Improvement in surgical instrumentations and techniques allows us to be more skilled to treat these lesions compared to the past, but in complex cases, complications and poor results are still present.
The difficulties encountered in these rare types of fracture are that small and often impacted articular fragments have to be addressed through extensile approaches and fixed with small screws countersunk beneath the joint surface.
Moreover, these types of fractures include a very wide pattern of lesions ranging from relatively simple lesions that interest only the capitellum, with good subchondral bone that can be treated with screw fixation through anatomical approaches, to very complex fractures with extensive fragmentation and comminution that require extensile approaches and that can be treated with plates, bone chips, external fixator, or even prosthetic replacement.
The preoperative planning of the fracture pattern is important for the choice of the approach that is a key element for a successful treatment of these injuries. A Kocher approach can be used for the simpler cases involving almost only the capitellum and the Kocher extensile approach for cases with a wider involvement of the trochlea. Only rarely olecranon osteotomy is necessary.
Screw fixation is always the first choice option. Especially in young patients, resorbable screws inserted with an “in-out technique” are our preferred choice. However, in case of severe comminution, many different strategies of treatment can be considered, like multiple pins, plates, or elbow replacement.
Improvement in surgical instrumentations and techniques allows us to be more skilled to treat these lesions compared to the past, but in complex cases, complications and poor results are still present.
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Marinelli, A., Guerra, E., Bettelli, G., Kantar, S.S. (2018). Capitellar and Trochlear Fracture: Treatment and Rehabilitation. In: Porcellini, G., Rotini, R., Stignani Kantar, S., Di Giacomo, S. (eds) The Elbow. Springer, Cham. https://doi.org/10.1007/978-3-319-27805-6_15
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