Capitellar Fractures

Abstract

Fracture of the capitellum is rare accounting for 1% of elbow injuries. It involves patients from 12 years of age and older. The most common mechanism is fall on an outstretched hand that results in an axial compressive force that is transmitted to the capitellum by the radial head. This mechanism of trauma causes fracture in the coronal plane of the humeral capitellum. In fact, Bryan and Morrey (Fig. 3) drafted the most popular classification of capitellar fractures: type I (Hans-Steinthal) coronal shear fracture resulting in an osteochondral fragment, type II (Kocher-Lorenz) coronal shear fracture resulting a cartilaginous fragment, type III multifragmentary fracture, and type IV (Mckee modification type) coronal shear fracture that includes the capitellum and trochlea. The treatment is mostly surgical, with a wide variety of access options. Some of them include lateral, extended lateral, anterolateral, and posterior. We do consider extended lateral as being the best choice, because it provides the most accurate angle to ensure anatomic reduction and stable internal fixation. The fixation must be stable enough to encourage early mobility and prevent eventual complications, such as elbow contracture, nonunion, and arthrosis.