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Lari A, Alrumaidhi Y, Martinez D, Ahmad A, Aljuwaied H, Alherz M, Prada C. Clinical Outcomes and Management Strategies for Capitellum and Trochlea Fractures: A Systematic Review. Orthop Res Rev 2024; 16:179-197. [PMID: 38947420 PMCID: PMC11214803 DOI: 10.2147/orr.s472482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/20/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Capitellum and trochlea fractures, also referred to as coronal shear fractures of the distal humerus, are infrequent yet challenging intra-articular fractures of the elbow. There are a variety of surgical approaches and fixation methods with often variable outcomes. This systematic review investigates interventions, outcomes and complications of capitellum and trochlea fractures. Methods A systematic review of studies published in MEDLINE, EMBASE, Web of Science and Cumulative Index to Nursing and Allied Health literature (CINAHL) was conducted to assess the clinical outcomes of capitellum and trochlea fractures managed surgically. Data on patient demographics, surgical approach, implant usage, postoperative outcomes and complications were compiled. Results Forty-one studies met the inclusion criteria with a total of 700 patients. Surgical interventions primarily utilized either the lateral (79%) or antero-lateral (15%) approaches with headless compression screws as the most common fixation method (68%). Clinical outcomes were measured using the Mayo Elbow Performance Index (MEPI) with a mean score of 89.9 (±2.6) and the DASH score with a mean of 16.9 (±7.3). Elbow range of motion showed a mean flexion of 126.3° (±19.4), extension of 5.71° (±11.8), pronation of 75.23° (±12.2), and supination of 76.6° (±9.8). The mean flexion-extension arc was 113.7° (±16.9), and the mean pronation-supination arc was 165.31° (±9.41). Complications occurred in 19.8% of cases, with re-interventions required in 8.3% of cases, mainly due to symptomatic implants and elbow stiffness requiring surgical release. Other complications included implant removal (10.4%), overall reported stiff elbows (6%), nerve palsies (2%), non-union (1.5%), and infection (1.2%). Conclusion The treatment of capitellum and trochlea fractures yields satisfactory outcomes but has a considerable rate of complications and reoperations primarily due to symptomatic implants and elbow stiffness. There is noteworthy variability in the achieved range of motion, suggesting unpredictable outcomes. Deficits in functionality and range of motion are common after surgery, especially with more complex injury patterns.
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Affiliation(s)
- Ali Lari
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Yasmen Alrumaidhi
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Diego Martinez
- Hospital of the Worker of Santiago: Hospital del Trabajador de Santiago, Santiago, Chile
| | - Amaar Ahmad
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Hamad Aljuwaied
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Mohammad Alherz
- Department of Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Carlos Prada
- St Joseph’s Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
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Fouché R, El Amiri L, Bestandji N, Uzel AP. Articular fracture of the distal humerus classified Dubberley 2b: Case report of two patients and review of the literature. Trauma Case Rep 2024; 51:101032. [PMID: 38655250 PMCID: PMC11036088 DOI: 10.1016/j.tcr.2024.101032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
Articular fractures of the distal humerus are rare, and even rarer are fractures involving the trochlea and capitellum in a single fragment, with no associated comminution. These fractures are classified as 2a according to the Dubberley classification and are rarely described in the literature. Two cases of Dubberley 2a fractures were treated at our hospital. The first case, involving a 68-year-old patient, was treated with a medial and a lateral approach, combined with posteroanterior fixation using 3 Herbert screws. In the 2nd case, a 16-year-old male was treated with a single lateral approach, permitting fixation with two Herbert screws. One of the two screws is inserted into the bone at the edge of the cartilage, with an anteroposterior trajectory that leaves the cartilage intact. We opted mainly for posteroanterior screw fixation in subchondral bone, which is less damaging to articular cartilage and soft tissues and has already demonstrated its reliability. No associated lesions were found, and no complications were encountered. Results were excellent, with Mayo Elbow Performance Index (MEPI) scores of 95 and 100 respectively. Herbert screw fixation therefore appears to be an option of choice for these fractures, although comparative studies are needed to evaluate the different treatments available.
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Affiliation(s)
- Raphaël Fouché
- University of the French Antilles, Department of Orthopedic Surgery, University Hospital of Guadeloupe, Route de Chauvel, 97139 Les Abymes, Guadeloupe
| | - Laela El Amiri
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 10 Avenue Baumann, 67400 Illkirch, France
| | - Nassim Bestandji
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 10 Avenue Baumann, 67400 Illkirch, France
| | - André-Pierre Uzel
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 10 Avenue Baumann, 67400 Illkirch, France
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Nagashree V, Dheenadhayalan J, Sundaram VP, Zackariya M, Sivakumar SP, Vembanan K, Rajasekaran S. Outcome determinants for coronal shear fractures of the distal humerus. INTERNATIONAL ORTHOPAEDICS 2024; 48:1295-1302. [PMID: 38502337 DOI: 10.1007/s00264-024-06151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Coronal shear fractures of the distal humerus involving the capitellum and trochlea are rare injuries. Internal fixation with headless compression screws provides a stable construct facilitating early mobilisation. Our study aimed to identify the key determinants of both radiological and functional outcomes of patients with distal humerus coronal shear fractures treated with internal fixation. METHODS A retrospective analysis of 61 patients with distal humerus coronal shear fractures who were treated surgically was done. Demographics, fracture morphology, time to surgery, operative details such as surgical approach and implant used, quality of reduction, time to union, and associated complications from hospital records. Radiological outcomes were assessed using plain radiographs, and the functional outcomes were by Oxford Elbow Score (OES) and Mayo Elbow Performance Index (MEPI). RESULTS Patients with anatomical reduction of the fracture had better functional outcomes and range of motion. The presence of posterior comminution of capitellum resulted in poorer outcomes (p = 0.03). Delayed presentation did not alter the outcome when the anatomical reduction was achieved. Myositis ossificans was noted in nine patients and non-union in five patients. Two patients developed avascular necrosis of the capitellum and arthritis of the elbow joint. CONCLUSION Anatomical reduction and posterior comminution are the two key determinants of the functional outcome in these coronal shear fractures of the distal humerus. Early mobilisation following a stable fixation is crucial in achieving a good outcome.
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Affiliation(s)
- Vasudeva Nagashree
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Jayaramaraju Dheenadhayalan
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India.
| | | | - Mohammed Zackariya
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - S P Sivakumar
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Kavinkumar Vembanan
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
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Liu Y, Gao Y, Xu X, Zhao Y, Wang H, Sun Q, Zhao B, Wang S, Zhou J. Elbow dislocation approach for complex elbow fractures: a cadaveric study. J Orthop Surg Res 2023; 18:978. [PMID: 38124085 PMCID: PMC10734051 DOI: 10.1186/s13018-023-04478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Approach need to be considered when surgeons dealt with complex elbow injuries and the choice of the approach is a challenge for surgeons due to the complex anatomy. On the basis of releasing the lateral collateral ligament, we modified the dislocation technique to pursue the superior exposure including not only the distal humeral surface but also the anterior facet of the coronoid process. METHODS A total of 4 cadaver specimens and 8 elbows were included in the study. Each cadaver provided one elbow for either the elbow dislocation approach or the posterior olecranon approach. The exposed distal articular surface of humerus, humeral capitulum, humeral trochlea, anterior trochlea of distal humerus, posterior trochlea of distal humerus and the ulnar coronoid process surface were marked by image J software and calculated for a comparison for each surgical approach. RESULTS The total distal humeral surface was exposed as a median of 98.2 (97.6, 99.6)% and 62.0 (58.3, 64.5)% for the elbow dislocation approach and the olecranon osteotomy approach (P < 0.001), the capitulum 100% and 32.4 (28.0, 39.2)% (P < 0.001), the trochlea 93.2(90.1, 96.9)% and 72.5 (65.2, 78.8)% (P < 0.001), the anterior trochlear articular surface 96.0(93.0, 97.4)% and 50.3 (43.6, 59.1)% (P < 0.001), the posterior trochlear articular surface 95.4 (93, 100)% and 100% (P = 0.76) and the articular surface of the coronoid process of ulna 71.3 (66.0, 74.2)% and 0% (P < 0.001). CONCLUSION For complex elbow fractures, the technique of elbow dislocation provides complete exposure of the distal humerus surface and a significant portion of the coronoid process surface, facilitating direct visualization for reduction and fixation. Level of evidence Anatomy Study; Cadaver Dissection.
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Affiliation(s)
- Yang Liu
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, China
- Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, China
| | - Yuling Gao
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, China
- Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, China
| | - Xiaopei Xu
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, China
- Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, China
| | - Yanrui Zhao
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, China
- Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, China
| | - Hanzhou Wang
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, China
- Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, China
| | - Qingnan Sun
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, China
- Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, China
| | - Binzhi Zhao
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, China
- Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, China
| | - Siyuan Wang
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, China
- Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, China
| | - Junlin Zhou
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, China.
- Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, China.
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Russo R, Guastafierro A, Mortellaro M, Minopoli P, Pietroluongo LR. Reconstruction of the Distal Humerus in a Post-traumatic Arthritic Elbow with a Frozen Osteochondral Allograft Using CT-based Preoperative 3D Planning: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00047. [PMID: 37276456 DOI: 10.2106/jbjs.cc.22.00691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We present a young patient with malunion of the Type IV distal humeral coronal shear fracture and post-traumatic arthritis of the elbow joint. He was treated with a frozen osteochondral allograft transplant using CT-based preoperative 3D planning. At 64 months after surgery, both the clinical and radiological results were satisfactory and no complications had been reported. CONCLUSION The precision of computer-aided surgical planning could assist in preoperative designing and preparation of a personalized elbow osteochondral allograft. Even in a chronic situation, a personalized treatment approach can allow for osseointegration and satisfactory clinical results.
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Affiliation(s)
- Raffaele Russo
- Department of Orthopedic Surgery, Pineta Grande Hospital, Caserta, Italy
- Department of Medicine and Health Sciences - University of Molise - Campobasso
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Choi S, Han JH, Shin DJ, Jo SW. Avascular necrosis of the capitellum after surgical treatment of a coronal shear fracture of the distal humerus: A case report. Int J Surg Case Rep 2023; 105:108045. [PMID: 37003230 PMCID: PMC10091049 DOI: 10.1016/j.ijscr.2023.108045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Coronal shear fractures of the distal humerus are rare and are expected to have a high incidence of avascular necrosis (AVN) due to the avascular nature of the capitellar bone fragment and limited soft tissue attachment. However, according to the literature published thus far, AVN is infrequently reported, and some studies suggest that it does not have a significant impact on clinical outcomes. CASE PRESENTATION Two female patients, one aged 72 and the other 70, presented with coronal shear fractures of distal humerus. Both patients were diagnosed with AVN of the capitellum 7 and 10 months after undergoing open reduction and internal fixation. One patient underwent hardware removal, while the other patient declined due to the absence of discomfort. However, at their final follow-up, both patients exhibited good clinical results. CLINICAL DISCUSSION The occurrence of AVN may be related to the severity of the initial injury, including posterior comminution. While some studies suggest that AVN of the capitellum may not affect clinical outcomes, hardware removal may be required in cases where there is intra-articular protrusion of the hardware. CONCLUSION Although AVN is a rare occurrence, even when it does occur, it may not significantly affect clinical outcomes. In this study, AVN may be associated with initial injury severity, and surgical treatment may make it possible to develop AVN. Moreover, considering the timing of the occurrence of AVN, it is believed that a close follow-up of more than one year will be required.
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Affiliation(s)
- Sung Choi
- Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, South Korea.
| | - Jae Hwi Han
- Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, South Korea
| | - Dong Ju Shin
- Department of Orthopedic Surgery, W Hospital, Daegu, South Korea
| | - Seong Woo Jo
- Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, South Korea
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Coronal Plane Articular Shear Fractures of the Distal Humerus. J Am Acad Orthop Surg 2023; 31:e235-e245. [PMID: 36727959 DOI: 10.5435/jaaos-d-21-00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
Coronal plane articular shear fractures of the distal humerus are a rare injury, comprising 6% of distal humerus fractures. The fracture can be easily missed on initial radiographs; therefore, a high index of suspicion is warranted. Radiographically obvious fractures are often more complex than initially appreciated, with plain radiographs often underestimating the extent of posterior comminution and trochlear involvement. Associated bony and ligamentous injuries are common. Anatomic reduction and internal fixation of displaced fractures is the standard of care because poor results have been described with nonsurgical treatment. However, the regional anatomy and the often-limited bone stock can make open reduction and internal fixation challenging. The lateral approach, with headless compression screws placed from anterior to posterior, is commonly used for simpler fracture patterns, but exposure and fixation of trochlea extension can be difficult. In the absence of posterior comminution, the anterolateral approach can enhance trochlea exposure and allow for a better trajectory for screw placement. Posterior comminution often requires locking plate fixation. Better results and lower complication rates have been reported for fractures with less fragmentation of the articular surface and those without posterior comminution. Contracture and symptomatic implants are the most common reasons for revision surgery.
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Long-Term Outcomes and Return to Work After Isolated Coronal Shear Fractures of the Capitellum. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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Zhang Y, Chang N, Athwal GS, King GJW. Arthroscopic reduction and internal fixation of capitellar and trochlear fractures: A case series. Shoulder Elbow 2023; 15:75-81. [PMID: 36895598 PMCID: PMC9990109 DOI: 10.1177/17585732211037617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/15/2022]
Abstract
Background In a simple isolated capitellar/trochlear fracture without extensive posterior comminution, arthroscopic reduction and internal fixation (ARIF) can provide an alternative option to open reduction internal fixation. The purpose of this retrospective case series was to report on the technique and outcomes of arthroscopic reduction and internal fixation of capitellar/trochlear fractures. Methods All patients that underwent ARIF at a single upper extremity referral centre in the last twenty years were reviewed. Patient demographics, preoperative, intraoperative, and postoperative records were obtained through chart review and telephone followup. Results Ten cases of ARIF were identified over a twenty year period performed by two surgeons. The average age of patients was 37 years (17-63 years), with nine females and one male. With an average followup of eight years, nine of ten patients had a mean range of motion from 0 to 142 degrees. Their average MEPI and PREE score were 93 ± 7 and 8 ± 14, respectively. Four patients had focal cartilage collapse with three that required a reoperation. There were no infections, nonunions, or arthroscopy related complications. Conclusion ARIF offers an alternative to ORIF for capitellar/trochlear fractures producing good results while providing better visualization of the fracture reduction and minimizing soft tissue dissection.
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Affiliation(s)
- Yiyang Zhang
- Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health
Care, Division of Orthopaedic Surgery, University of Western
Ontario, London, ON, Canada
| | - Nicholas Chang
- Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health
Care, Division of Orthopaedic Surgery, University of Western
Ontario, London, ON, Canada
| | - George S Athwal
- Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health
Care, Division of Orthopaedic Surgery, University of Western
Ontario, London, ON, Canada
| | - Graham JW King
- Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health
Care, Division of Orthopaedic Surgery, University of Western
Ontario, London, ON, Canada
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Kim BS, Jung KJ, Kim KB, Park SS. Treating AO Type C2-3 Distal Humerus Fractures With the Anconeus Flap Transolecranon Approach. Orthopedics 2022; 45:e326-e334. [PMID: 35947456 DOI: 10.3928/01477447-20220805-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We evaluated the outcomes of precontoured locking plate fixation with the anconeus flap transolecranon (AFT) approach to treating AO type C2-3 comminuted intra-articular distal humerus (IDH) fractures among active patients. Thirty-six patients (age <65 years) with IDH fractures treated with precontoured distal humerus locking plate fixation were divided into 2 groups: group 1 (n=18; transolecranon [TO] approach) and group 2 (n=18; AFT approach). The radiographic examination included assessments of implant failure, fracture site union, and olecranon osteotomy site union. Clinical examination included assessments of operating time, range of motion (ROM), Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder and Hand (DASH) score, and complications. The mean follow-up time was 25.2 months (range, 18-79 months). The mean operating time was 134.3 minutes and was significantly longer for group 2 (AFT; 141.2 minutes) than for group 1 (TO; 124.2 minutes). The mean olecranon osteotomy site union time was significantly longer in group 2 (7.4 weeks) than in group 2 (4.0 weeks). Olecranon osteotomy site resorption occurred among 6 of 18 patients only in group 2. No significant difference in ROM (flexion, 130°; extension, -0.7°), MEPS (85.7 points), DASH score (20.0 points), or frequency of major complications (TO, 5; AFT, 6) was observed between the groups. Our results showed no advantage of the AFT approach over the TO approach, despite preserving the anconeus. Prospective randomized trials will be necessary to compare the AFT and TO approaches for treating comminuted IDH fractures. [Orthopedics. 2022;45(6):e326-e334.].
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Vicenti G, Bizzoca D, Zaccari D, Buono C, Carlet A, Solarino G, Giorgino R, Santolini E, Lunini E, Zavattini G, Ottaviani G, Carrozzo M, Simone F, Marinelli A, Rotini R, Franchini A, Moretti B. Choice of treatments of the coronal shear fractures of the humerus. A national survey of Italian AO members. Injury 2022; 54 Suppl 1:S78-S84. [PMID: 36400627 DOI: 10.1016/j.injury.2022.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Coronal shear fractures of the distal humerus are uncommon injuries representing 6% of distal humeral fractures. There is no univocal consensus about the correct management of this type of fracture. A national survey was conducted to gain more insight into the current classification, diagnosis and treatment of coronal shear fractures in Italy. MATERIALS AND METHODS A postal survey was sent to all AO Italian members including residency orthopaedic surgeons. The survey consisted of general questions about personal experience in the management of these fractures: types of classification systems used, surgical approaches, treatment options and rehabilitation programs. RESULTS 114 orthopaedic surgeons answered a 13-items questionnaire. The most used classification system was AO/OTA (72,8%). Independent screws and if necessary plates were the most answered regarding surgical treatment (81,6%). The most encountered post-surgical complication was stiffening of the elbow (81,6%). CONCLUSION An algorithm of treatment has been proposed. To better classify coronal shear fractures, the authors recommended the integration of two classification systems: AO and Dubberley classifications. In the case of posterior wall comminution, a Kocher extensile approach is recommended, otherwise, if a posterior wall is intact, Kocher or Kaplan approach can be used. The posterior transolecranic approach can be reserved to Dubberley type III or AO 13B3.3. The best treatment choice is represented by independent screws and plates placed according to fracture patterns while arthroplasty is indicated when a stable ORIF is not possible. Mobilization is postponed for about 2 weeks.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Domenico Zaccari
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Claudio Buono
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Arianna Carlet
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Emmanuele Santolini
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Enricomaria Lunini
- Orthopedics and Trauma Unit, ASST Lariana Ospedale Sant'Anna, Como, Italy
| | - Giacomo Zavattini
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Guglielmo Ottaviani
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Filippo Simone
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | | | - Roberto Rotini
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Franchini
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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Li J, Martin VT, Li DT, Su ZW, Wu YH, Gan JY, Liu QL, Yu B. Lateral epicondyle osteotomy approach vs. olecranon osteotomy approach: an anatomic study of cadavers. J Shoulder Elbow Surg 2022; 31:2339-2346. [PMID: 35613695 DOI: 10.1016/j.jse.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Exposure of the articular surface is the key to successful open reduction and internal fixation treatment for coronal shear fractures of the distal humerus. The olecranon osteotomy approach has previously been described as one of the most effective exposure approaches. Nevertheless, this approach cannot expose the anterior trochlea, and it is impossible to reduce and fix the capitellum under direct vision. The purpose of this study was to compare the exposure of the articular surface of the distal humerus between the lateral epicondyle osteotomy approach (group L) and the olecranon osteotomy approach (group O). METHODS Each approach was performed on 8 freshly frozen upper limbs of adult cadavers. After each approach was completed, a 0.5-mm Kirschner wire is inserted along the edge to mark the visible part of the articular surface. Then, the soft tissue of each elbow is removed, and a surface-scanning system is used to create a digital 3-dimensional model. The visible part of the articular surface obtained by each surgical approach was mapped and quantified using markers created by Kirschner wires. RESULTS The lateral epicondyle osteotomy approach and the olecranon osteotomy approach exposed 0.8 ± 0.0 and 0.6 ± 0.0 of the distal humeral articular surface (P < .001), 1.0 ± 0.0 and 0.3 ± 0.1 of the capitellum (P < .001), 0.6 ± 0.0 and 0.7 ± 0.0 of the trochlea (P < .001), 0.7 ± 0.0 and 0.5 ± 0.1 of the anterior trochlea (P < .001), and 0.5 ± 0.0 and 1.0 ± 0.0 of the posterior trochlea, respectively (P < .001). CONCLUSION Compared with the olecranon osteotomy approach, the lateral epicondyle osteotomy approach could more fully expose the total articular surface of the distal humerus, capitellum, and anterior trochlea, but the olecranon osteotomy approach could more fully expose the trochlea and posterior trochlea.
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Affiliation(s)
- Jie Li
- Department of Orthopaedics and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Vidmi Taolam Martin
- Department of Orthopaedics and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Dong-Tai Li
- Department of Orthopaedics and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhi-Wen Su
- Department of Orthopaedics and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - You-Hui Wu
- Department of Orthopaedics and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jing-Yue Gan
- Department of Orthopaedics and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qiao-Lan Liu
- Department of Orthopaedics and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| | - Bo Yu
- Department of Orthopaedics and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Fisher KJ, Livesey MG, Sax OC, Gilotra MN, O'Hara NN, Henn RF, Hasan SA. Are Outcomes After Fixation of Distal Humerus Coronal Shear Fractures Affected by Surgical Approach? A Systematic Review and Meta-analysis. JSES Int 2022; 6:1054-1061. [DOI: 10.1016/j.jseint.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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14
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Hackl M, Lanzerath F, Ries C, Harbrecht A, Leschinger T, Wegmann K, Müller LP. Trans-fracture approach for ORIF of coronal shear fractures of the distal humerus. Arch Orthop Trauma Surg 2022; 143:2519-2527. [PMID: 35731264 PMCID: PMC10110670 DOI: 10.1007/s00402-022-04501-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Open reduction and internal fixation (ORIF) of comminuted coronal shear fractures of the distal humerus is challenging. When a concomitant lateral condyle fracture is present, it may be used for a trans-fracture approach to facilitate exposure and fracture reduction. This study aimed to investigate the frequency of lateral condyle fractures in coronal shear fractures of the distal humerus and analyze fracture reduction, fracture union and clinical results following ORIF through a trans-fracture approach. MATERIALS AND METHODS All adult patients who underwent treatment for an acute distal humerus fracture during a three-year period in our level-one trauma center were identified. All fractures were classified according to the Orthopaedic Trauma Association (OTA/AO) fracture classification system and all B3 fractures were classified according to the Dubberley classification. B3 fractures with a concomitant radial condyle fracture were identified. The clinical and radiological results, (Mayo Elbow Performance Score = MEPS, Visual Analogue Scale = VAS, range of motion), complications and revision surgeries were analyzed. RESULTS 53 patients (mean age 52 ± 19 years) were identified. 13 fractures (24.5%) were B3 fractures. Four of them (30.8%) had a concomitant radial condyle fracture. All of these patients underwent ORIF with headless cannulated compression screws and a (postero-)lateral locking plate through a trans-fracture approach. At a minimum follow-up of 24 months, the MEPS was 88 ± 12 points, the VAS was 2 ± 1 and the range of motion was 118° ± 12°. All fractures showed anatomic reduction. One patient developed partial avascular necrosis and underwent arthrolysis at 6 months. One patient underwent partial hardware removal and lateral collateral ligament bracing at 6 months. CONCLUSIONS Lateral condyle fractures are present in about one third of coronal shear fractures of the distal humerus. This injury can be used for a trans-fracture approach to facilitate exposure and to reliably achieve anatomic fracture reduction.
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Affiliation(s)
- Michael Hackl
- Faculty of Medicine, University of Cologne, Cologne, Germany. .,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany.
| | - Fabian Lanzerath
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Christian Ries
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Harbrecht
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Tim Leschinger
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Kilian Wegmann
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Lars Peter Müller
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
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15
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Nolte PC, Midtgaard K, Miles JW, Tanghe KK, Provencher MT. The Effect of Buttress Plating on Biomechanical Stability of Coronal Shear Fractures of the Capitellum: A Cadaveric Study. J Hand Surg Am 2022:S0363-5023(21)00801-7. [PMID: 35153076 DOI: 10.1016/j.jhsa.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/21/2021] [Accepted: 12/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare, using a cadaveric model, the biomechanical properties of headless compression screws (HCSs) and HCSs augmented with a buttress plate (BP) in capitellar fractures. METHODS Twenty pairs of fresh-frozen humeri (mean age, 46.3 years; range, 33-58 years) were used. The soft tissue was removed, and a Dubberley type IA capitellar fracture was created. One specimen in each pair was randomly assigned to receive either two 2.5-mm HCSs (HCS group) or two 2.5-mm HCSs augmented with an anterior 2.4-mm BP (HCS + BP group). This resulted in a similar distribution of the left and right humeri between the groups. Cyclic loading was performed, and displacement of the capitellum at 50, 100, 250, 500, 1,000, and 2,000 cycles was assessed using a motion capture system. This was followed by load-to-failure testing, wherein the load at a displacement of 1 and 2 mm was recorded. Failure was defined as 2-mm displacement. RESULTS During cyclic loading, there were no significant differences in the displacement between the HCS and HCS + BP groups at any of the assessed cycles. During load-to-failure testing, no significant strength differences were observed in the load at 1-mm displacement between the HCS (mean: 449.8 N, 95% CI: 283.6-616.0) and HCS + BP groups (mean: 606.2 N, 95% CI: 476.4-736.0). However, a significantly smaller load resulted in a 2-mm displacement of the fragment in the HCS group (mean: 668.8 N, 95% CI: 414.3-923.2) compared with the HCS + BP group (mean: 977.5 N, 95% CI: 794.1-1,161.0). CONCLUSIONS Anterior, low-profile buttress plating in addition to HCSs results in a significantly higher load to failure compared with HCSs alone in a biomechanical Dubberley type IA capitellar fracture model. CLINICAL RELEVANCE The addition of an anterior BP may be considered to improve initial stability in select cases such as osteoporotic patients or when the posterolateral column is frail.
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Affiliation(s)
- Philip C Nolte
- Steadman Philippon Research Institute, Vail, Colorado; BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen, Germany
| | - Kaare Midtgaard
- Steadman Philippon Research Institute, Vail, Colorado; Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Norwegian Armed Forces Joint Medical Services, Forsvarsvegen, Norway
| | - Jon W Miles
- Steadman Philippon Research Institute, Vail, Colorado
| | - Kira K Tanghe
- Steadman Philippon Research Institute, Vail, Colorado
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado; Steadman Clinic, Vail, Colorado.
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Tyllianakis M, Solou K, Lakoumentas J, Panagopoulos A. Long-Term Functional Outcomes and Complications of Intra-Articular (AO type B, C) Distal Humerus Fractures in Adults: A Retrospective Review. Cureus 2022; 14:e21094. [PMID: 35165554 PMCID: PMC8828691 DOI: 10.7759/cureus.21094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Treatment of intra-articular fractures of the distal humerus is challenging due to their complexity, comminution, and associated complications. The evolution of surgical approaches and the design of elbow-specific implants over the last decades have failed to improve clinical and radiological outcomes. Studies are sparse regarding the long-term influence of surgical treatment of these types of fractures in the upper limb function. The purpose of the current study was to retrospectively review the long-term functional outcome and complications of all intraarticular (AO type B, C) distal humerus fractures treated surgically in a university hospital during the last 25 years. Material and methods The study included patients who were surgically treated for an intra-articular distal humerus fracture between March 1991 and May 2016. Our initial search, using ICD-10 codes, identified 63 patients in the specific time period. Twelve patients had died, nine declined to participate, eight had emigrated, nine could not be located and one patient was excluded as he suffered from quadriplegia unrelated to the initial injury. The remaining 25 patients (mean age at surgery 44.2±19.67) were included in a follow-up study protocol. Functional outcome was evaluated according to Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Pain was assessed using the Numerical Pain Rating Scale (NPRS) and subjects were asked to rate their satisfaction. Perioperative and late complications were recorded as well. Results The average follow-up was 158.16 ± 73.73 months. The average score was 89.4 ± 12.36 for MEPS, 42.68 ± 4.03 for OES, and 8.1 ± 15.38 for the QuickDASH. The patient satisfaction was rated 3.8 ± 1.08 on average. The mean flexion of the affected elbow was 137.6 ± 12.68 degrees while extension deficit was present in 14/25 patients, with a mean of 8.6 ± 8.96 degrees. We did not observe any mal- or non-unions. The re-operation rate was 32% primarily due to stiffness and irritation from the hardware. We noticed one spontaneously resolved ulnar nerve palsy, one combined radial, and ulnar nerve palsy after extensive arthrolysis that also resolved two cases of heterotopic ossification, one case of implant failure, and two cases of infection - one superficial, which was managed with antibiotics, and the other was deep managed with surgical drainage. Conclusions In our series, we found a satisfying range of motion, good functional outcome, and adequate ability to perform daily activities at a very long follow-up. Posttraumatic arthritis, whenever present, does not seriously affect functional performance. Level of evidence: IV
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Coronal Shear Fractures of the Distal Humerus. J Funct Morphol Kinesiol 2022; 7:jfmk7010007. [PMID: 35076551 PMCID: PMC8788494 DOI: 10.3390/jfmk7010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent.
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18
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Akhtar M, Keshkar S, Barman R. Functional outcome of delayed surgical fixation of capitellar fractures treated by open reduction and internal fixation with herbert screw. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2022. [DOI: 10.4103/jotr.jotr_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Borbas P, Loucas R, Loucas M, Vetter M, Hofstede S, Ernstbrunner L, Wieser K. Biomechanical stability of complex coronal plane fracture fixation of the capitellum. Arch Orthop Trauma Surg 2022; 142:3239-3246. [PMID: 34424387 PMCID: PMC9522805 DOI: 10.1007/s00402-021-04126-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Coronal plane fractures of the distal humerus are relatively rare and can be challenging to treat due to their complexity and intra-articular nature. There is no gold standard for surgical management of these complex fractures. The purpose of this study was to compare the biomechanical stability and strength of two different internal fixation techniques for complex coronal plane fractures of the capitellum with posterior comminution. MATERIALS AND METHODS Fourteen fresh frozen, age- and gender-matched cadaveric elbows were 3D-navigated osteotomized simulating a Dubberley type IIB fracture. Specimens were randomized into one of two treatment groups and stabilized with an anterior antiglide plate with additional anteroposterior cannulated headless compression screws (group antiGP + HCS) or a posterolateral distal humerus locking plate with lateral extension (group PLP). Cyclic testing was performed with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure. RESULTS There was no significant difference in displacement during 2000 cycles (p = 0.291), stiffness (310 vs. 347 N/mm; p = 0.612) or ultimate load to failure (649 ± 351 vs. 887 ± 187 N; p = 0.140) between the two groups. CONCLUSIONS Posterolateral distal humerus locking plate achieves equal biomechanical fixation strength as an anterior antiglide plate with additional anteroposterior cannulated headless compression screws for fracture fixation of complex coronal plane fractures of the capitellum. These results support the use of a posterolateral distal humerus locking plate considering the clinical advantages of less invasive surgery and extraarticular metalware. LEVEL OF EVIDENCE Biomechanical study.
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Affiliation(s)
- Paul Borbas
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Rafael Loucas
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Marios Loucas
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Maximilian Vetter
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Simon Hofstede
- grid.5801.c0000 0001 2156 2780Institute of Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Karl Wieser
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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20
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BAYDAR MEHMET, AYKUT SERKAN, MERT MUHAMMED, KESKINBIÇKI M, AKDENIZ H, ÖZTÜRK KAHRAMAN. ISOLATED CAPITELLAR FRACTURE FIXATION WITH HEADLESS SCREWS IN DIFFERENT CONFIGURATIONS. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e244357. [PMID: 35431622 PMCID: PMC8979352 DOI: 10.1590/1413-785220223001e244357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 06/02/2021] [Indexed: 11/22/2022]
Abstract
Introduction We evaluated the clinical and radiological outcomes of capitellar fractures treated with modified screw insertion (inserting the first fixation screw anteroposteriorly and the second screw posteroanteriorly), a technique that can be applied with a minimally invasive lateral elbow approach. Materials and Methods Twenty-one isolated capitellum fractures that were surgically treated were included in the study. Fixation was achieved with two headless cannulated compression screws placed in anteroposterior and posteroanterior order using the modified lateral elbow approach. The Broberg-Morrey rating system was used to assess the post-operative functional status of the patients. Results According to the Broberg-Morrey criteria, the mean score was 92.7 (77-100) and 13 cases had excellent, 7 had good, and 1 had fair results. None of the patients developed avascular necrosis or heterotopic ossification. According to the Broberg-Morrey arthrosis score, two cases had Grade 1 and one had Grade 2 arthrosis. One patient had a superficial wound site infection that was treated with antibiotics, and in one case a 60° extension loss was observed in the elbow. Conclusion Treatment of isolated capitellar fractures with 2 headless screws placed anteroposteriorly and posteroanteriorly can provide stable fixation and is less traumatic for the elbow joint. Level of Evidence IV; Therapeutic Studies - Investigating the results of treatment.
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21
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Tomori Y, Nanno M, Sonoki K, Majima T. Surgical outcomes of coronal shear fractures of the distal humerus in the elderly. J NIPPON MED SCH 2021; 89:81-87. [PMID: 34526454 DOI: 10.1272/jnms.jnms.2022_89-202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate the clinical outcomes of the elderly with coronal shear fractures (CSFs) of the distal humerus who had undergone open reduction and internal fixation (ORIF). METHODS Between April 2002 and March 2019, eight elderly patients (76.3 ± 5.1 years)with CSFs of the distal humerus were investigated retrospectively. Postoperative complications, the range of motion (ROM) of the elbow joint, and functional elbow scoring (Mayo elbow performance score; MEPS) were assessed. RESULTS The mean follow-up duration was 23.6 ± 13.9 months. CSFs were treated by a buried implantable headless screw or Kirshner wires or bioresorbable screw with/without lateral locking plates. There were no superficial or deep infections, or elbow joint instability. Seven patients obtained fracture healing, but one patient showed non-union. Osteochondritis dissecans was present in one patient. Three patients showed step-off deformity (> 2 mm) of the articular surface. Two patients displayed a collapse of the fractured articular surface. A patient with severe comminution of both the capitellum and the trochlear showed the collapse of the whole articular surface with osteonecrosis of the capitellum and trochlea. Mean the range of motion of the elbow were flexion, 116.3±12.7° and extension, -28.8±14.1°. The mean MEPS was 78.8±10.2 points, representing patients who scored an excellent (n=1), good (n=3), and fair (n=4). CONCLUSION ORIF yielded satisfactory outcomes for theelderly with noncomminuted CSF of the distal humerus. However, the cases with comminuted articular fragment or complex posterior fractures were still challenging.
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Affiliation(s)
- Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School Hospital
| | - Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School Hospital
| | - Kentaro Sonoki
- Department of Orthopaedic Surgery, Nippon Medical School Hospital
| | - Tokifumi Majima
- Department of Orthopaedic Surgery, Nippon Medical School Hospital
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22
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Borbas P, Vetter M, Loucas R, Hofstede S, Wieser K, Ernstbrunner L. Biomechanical stability of simple coronal shear fracture fixation of the capitellum. J Shoulder Elbow Surg 2021; 30:1768-1773. [PMID: 33529777 DOI: 10.1016/j.jse.2020.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Coronal shear fractures of the capitellum are rare, and their surgical management is challenging, without a defined gold standard. The purpose of this study was to compare the biomechanical stability of 3 different internal fixation techniques for simple coronal shear fractures of the capitellum without posterior comminution. METHODS Dubberley type IA fractures of the capitellum were created in 18 cadaveric elbows, which were age and sex matched to the following 3 internal fixation groups: (1) two anteroposterior cannulated headless compression screws (HCSs), (2) two anteroposterior HCSs with an additional anterior antiglide plate (antiGP), and (3) a posterolateral distal humeral locking plate (LP). All fixation techniques were cyclically loaded with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure. RESULTS Fragment displacement under cyclic loading with 2000 cycles did not show a significant difference (P = .886) between the 3 groups. The HCS group showed the highest stiffness compared with the HCS-antiGP and LP groups (602 N/mm vs. 540 N/mm vs. 462 N/mm, P = .417), without reaching a statistically significant difference. Ultimate load to failure was also not significantly different on comparison of all 3 groups (P = .297). CONCLUSIONS Simple coronal shear fractures of the capitellum are biomechanically equally stabilized by HCSs compared with HCSs with an additional antiGP or a posterolateral distal humeral LP. In view of the advantages of less (invasive) metalware, the clinical use of 2 isolated anteroposterior HCSs appears reasonable.
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Affiliation(s)
- Paul Borbas
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.
| | - Maximilian Vetter
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Rafael Loucas
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Simon Hofstede
- Institute of Biomechanics, Eidgenössische Technische Hochschule Zürich (ETH Zürich), Zürich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
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Li J, Martin VT, Su ZW, Li DT, Zhai QY, Yu B. Lateral epicondyle osteotomy approach for coronal shear fractures of the distal humerus: Report of three cases and review of the literature. World J Clin Cases 2021; 9:4318-4326. [PMID: 34141796 PMCID: PMC8173410 DOI: 10.12998/wjcc.v9.i17.4318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/24/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronal shear fractures of the distal humerus are rare injuries and are technically challenging to manage. Open reduction and internal fixation (ORIF) has become the preferred treatment because it provides anatomical reduction, stable internal fixation, and early motion, but the optimal surgical approach remains controversial.
CASE SUMMARY We report three cases of coronal shear fractures of the distal humerus treated successfully by ORIF via a novel surgical approach, in which lateral epicondyle osteotomy was performed based on the extended lateral approach. We named the novel surgical approach the lateral epicondyle osteotomy approach. All patients underwent surgical treatment and were discharged successfully. All patients had excellent functional results according to the Mayo elbow performance score. The average range of motion was 118° in flexion/extension and 172° in pronation/ supination. Only case 2 had a complication, which was implant prolapse.
CONCLUSION We demonstrated that the lateral epicondyle osteotomy approach in ORIF is effective and safe for coronal shear fractures of the distal humerus.
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Affiliation(s)
- Jie Li
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Vidmi Taolam Martin
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Zhi-Wen Su
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Dong-Tai Li
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Qi-Yi Zhai
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Bo Yu
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
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Van Nguyen T, Kholinne E, AlSomali K, Cho CH, Koh KH, Jeon IH. Technique for Arthroscopic-Assisted Reduction and Cannulated Screw Fixation for Coronal Shear Fractures of the Distal Humerus. Arthrosc Tech 2021; 10:e949-e955. [PMID: 33981535 PMCID: PMC8084756 DOI: 10.1016/j.eats.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023] Open
Abstract
Several articles have described arthroscopic fixation of coronal shear fractures of the distal humerus. However, not all of them have used purely arthroscopic techniques. In this Technical Note we describe another technique for intra-articular distal humeral fracture fixation using arthroscopy alone. Standard proximal anteromedial, proximal anterolateral, and posterolateral viewing portals are established with soft spot portal for reduction. During intra-articular examination, the fragment involving the capitellum and the trochlea as 1 piece is detected. Closed manipulative reduction under anesthesia is conducted with distraction, varus force, and gradual elbow extension. After closed reduction, reduction of the fragment more precisely under arthroscopic visualization using probe and elevator is performed. The fragment is temporarily fixed using 2 Kirschner wires from posterior direction. Anatomic reduction is confirmed with an image intensifier. Screw guide pin is inserted posteroanteriorly under image intensification, and a headless compression screw is placed over each wire. We describe a safe, reproducible, and minimal invasive technique for the arthroscopic treatment of coronal shear fractures of the distal humerus.
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Affiliation(s)
- Thanh Van Nguyen
- Department of Orthopedic Surgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Erica Kholinne
- Department of Orthopaedic Surgery, St. Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia,Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Khalid AlSomali
- Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea,Department of Orthopaedic Surgery, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Chang-Ho Cho
- Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea,Address correspondence to In-Ho Jeon, M.D., Ph.D., Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, Republic of Korea, 138-736.
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Yoshida S, Sakai K, Nakama K, Matsuura M, Okazaki S, Jimbo K, Shirahama M, Shiba N. Treatment of Capitellum and Trochlea Fractures Using Headless Compression Screws and a Combination of Dorsolateral Locking Plates. Cureus 2021; 13:e13740. [PMID: 33842118 PMCID: PMC8021482 DOI: 10.7759/cureus.13740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction This study aimed to evaluate the clinical outcomes of 16 patients with capitellum and trochlea fractures that were treated using isolated headless compression screws or a combination of dorsolateral locking plates and anterior-to-posterior screws. We also investigated the presence of lateral epicondyle fragments because this fragment is especially important when making decisions regarding the surgical approach and implants. Materials and methods We conducted a retrospective analysis of 16 patients with capitellum and trochlea fractures. Clinical, radiographic (based on CT scans), and elbow-specific outcomes, including the Mayo Elbow Performance Index (MEPI), were evaluated at a mean of 23.5 months postoperatively. Results The average MEPI scores in patients with Dubberley type A (non-posterior comminution) and type B (posterior comminution) fractures were 88 and 78, respectively (p=0.08). Headless compression screws were used in 10 cases of type A fracture and one case of type B fracture. A combination of dorsolateral locking plates and anterior-to-posterior screws was used in five cases of type B fracture. Hardware loosening was seen in one case of type B fracture with isolated screw fixation. The presence of a lateral epicondyle fragment was significantly associated with the type B group (6/6 patients; 100%). In contrast, patients in the type A group rarely had posterior comminution of the lateral epicondyle fragment (2/10 patients; 20%). Conclusions Capitellum and trochlea fractures with posterior comminution, which typically presented with lateral epicondylar fragments, were safely and effectively treated with a combination of dorsolateral locking plates and anterior-to-posterior screws through lateral approaches. Cases without posterior comminution were treated with headless compression screws with no complications. The Dubberley classification system provides helpful information to determine the fixation strategy.
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Affiliation(s)
- Shiro Yoshida
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, JPN.,Department of Orthopedic Surgery, St. Mary's Hospital, Kurume, JPN
| | - Kensuke Sakai
- Department of Orthopedic Surgery, St. Mary's Hospital, Kurume, JPN
| | - Kenjiro Nakama
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, JPN
| | - Mitsuhiro Matsuura
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, JPN
| | - Shingo Okazaki
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, JPN
| | - Kotaro Jimbo
- Department of Orthopedic Surgery, St. Mary's Hospital, Kurume, JPN
| | - Masahiro Shirahama
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, JPN
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, JPN
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Mukohara S, Mifune Y, Inui A, Nishimoto H, Kurosawa T, Yamaura K, Yoshikawa T, Waki T, Kuroda T, Niikura T, Kuroda R. Effects of trochlear fragmentation on functional outcome in coronal shear fractures: a retrospective comparative study. JSES Int 2021; 5:571-577. [PMID: 34136873 PMCID: PMC8178597 DOI: 10.1016/j.jseint.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Coronal shear fractures of the distal humerus are rare injuries, and fragmentation of the capitellum and trochlea with posterior comminution is challenging for surgeons. We retrospectively evaluated the functional outcomes of patients with coronal shear fractures managed with open reduction and internal fixation, focusing on the number of trochlea fragments in Dubberley type 3B fractures. Materials and methods The functional outcomes of 25 patients, including 8 patients with type 3B fractures, with a mean age (and standard deviation) of 57 ± 20 years, were evaluated at a mean follow-up duration of 15 ± 9 months. Type 3B fractures were classified into two groups: those with two trochlea fragments or less group (group A) and those with three or more fragments (group B). Patient outcomes were assessed with clinical and radiographic examination, range of motion, and the Mayo Elbow Performance scale (MEPS). Results Two patients with type 3B in group B experienced nonunion, and two patients with type 3B in group A and 1 patient with type 1B demonstrated avascular necrosis on radiographs. The average MEPS score was 96.3 points (range, 70-100), with 18 excellent, 5 good, and 1 fair results. The average range of motion was 10 ± 8 to 130 ± 12. The MEPS score worsened as Dubberley classification progressed from type 1 to type 3 (98.3 vs. 96.7 vs. 88, P = .014, respectively) and subtypes A to B (97.9 vs. 90, P = .014, respectively). In comparing groups A and B, the MEPS score was significantly worse in group B (93.8 vs. 76.3, P = .006). Conclusion Our open reduction and internal fixation results were largely good, although functional outcomes were diminished as Dubberley classification progressed from type 1 to type 3 and subtype A to B. Type 3B fractures with three trochlea fragments or more in the elderly were the most difficult to treat with open reduction and internal fixation and possibly 1-term total elbow arthroplasty.
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Affiliation(s)
- Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Kurosawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Waki
- Department of Orthopedic Surgery, Akashi Medical Center, Akashi, Japan
| | - Tsukasa Kuroda
- Department of Orthopaedic Surgery, Shinsuma Hospital, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Tarallo L, Novi M, Porcellini G, Giorgini A, Micheloni G, Catani F. Surgical tips and tricks for coronal shear fractures of the elbow. Arch Orthop Trauma Surg 2021; 141:261-270. [PMID: 32495117 DOI: 10.1007/s00402-020-03500-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/31/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Coronal shear fractures of the distal humerus represent an uncommon lesion and could be burdened by high complications. This complex lesion requires an accurate reduction and surgical fixation for a better outcome. Different techniques have been described, however no standard protocol have been proposed. Purpose of this retrospective study, is to evaluate the clinical and radiological outcome with posterior cannulated self-tapping headless screws followed by an early-active-motion protocol and to outline the surgical tips and tricks for different fracture patterns. MATERIALS AND METHODS From 2013 to 2019, a consecutive series of 24 patients with coronal shear fracture undergoing ORIF were included in the study. Fractures were classified according to Dubberley's classification. Cannulated self-tapping headless screws were used to fix the fragments. When necessary, additional cannulated half-threaded screws on the lateral edge of the humerus were used, as well as bone chips and fibrin sealant on severe comminution. All patients underwent an assisted early-active-motion rehabilitation protocol. Mean follow-up was 30 months; patients underwent standard X-rays and clinical outcome assessment with range of motion, Broberg and Morrey score and MEPI score. RESULTS Surgical fixation with headless screw guaranteed complete healing of all shear fractures examined, no loss of reduction were reported. ROM assessment showed good results with an average arc of 113.1°. Excellent to good Broberg-Morrey and MEPI score were reported. No cases of avascular necrosis nor post-traumatic osteoarthritis resulted in our series. Complications occurred in 16.6% of the patients. CONCLUSION Coronal shear fracture represents a challenging injury to treat. Anatomical reduction and the use of cannulated self-tapping headless screws from posterior provide a stable fixation, high union rates and good elbow function, with a low cartilage damage and risks of necrosis over 2 years of follow-up. LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Luigi Tarallo
- Orthopaedic and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Michele Novi
- Orthopaedic and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Giuseppe Porcellini
- Orthopaedic and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Andrea Giorgini
- Orthopaedic and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Gianmario Micheloni
- Orthopaedic and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Fabio Catani
- Orthopaedic and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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Lu Y, Fu L, Ma T, Xu YB, Xu LP, Song Z, Fan S, Wang Q, Sun L, Xue HZ, Li Z, Zhang K, Liu DY, Ren C. Clinical Efficacy of Vertical or Parallel Technique of a Micro-Locking Plate for Treatment of Dubberley B-Type Capitellar Fractures. Orthop Surg 2021; 13:207-215. [PMID: 33426763 PMCID: PMC7862171 DOI: 10.1111/os.12880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the clinical efficacy of micro‐locking plate through vertical or parallel technique for treatment of Dubberley B‐type capitellar fractures. Methods A retrospective analysis was performed in 24 patients (17 males and seven females, with an average age of 44.9 years, range from 19 to 75 years) with capitellar fractures that were treated with micro‐locking plate using vertical or parallel technique between January 2016 to January 2019. The inclusion criteria include closed capitellar fracture, normal anterior elbow joint movement before injury, and recent capitellar fracture with injury within past 3 weeks. Fractures classified according to Dubberley included four cases of type IB, eight cases of type IIB, and 12 cases of type IIIB. Radiographic evaluation was performed. Surgery time, blood loss, range of motion of the elbow, forearm rotation, and complications were recorded. Elbow joint function was evaluated by Mayo Elbow Performance Score (MEPS). Results The mean follow‐up period was 19.6 months (range, 12–36 months). The average clinical healing time for fractures was 11.2 ± 3.2 weeks (range, 8–20 weeks). Fracture united in all patients. Two patients showed slight delayed union, but union was achieved eventually. The mean time from injury to surgery was 6.3 ± 3.1 days (range, 2–15 days). The average surgical time was 68.1 ± 11.5 min (range, 50–90 min), and the mean blood loss was 75.2 ± 26.5 mL (range, 40–120 mL). The mean range of flexion was 122.5° ± 10.5°(range, 95°–140°). The mean range of extension was 8.5° ± 5.8°(range, 0°–20°). The mean range of pronation was 79.7° ± 8.0°(range, 65°–90°). The mean range of supination was 80.5° ± 7.1°(range, 60°–90°). The mean MEPS at final follow‐up was 89.8 ± 9.0 (range, 60–100). Based on the MEPS, 18 (75%) patients had excellent, five (20.8%) patients had good, and one (4.2%) patient had fair. None of the 24 patients suffered vascular or nerve injury. One patient showed superficial infection, which was treated with surgical dressing. Conclusions The vertical or parallel technique of the micro‐locking plate is an excellent method for treating Dubberley B‐type capitellar fractures.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.,Bioinspired Engineering and Biomechanics Center (BEBC), The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Lei Fu
- Orthopaedics Institute of Chinese PLA, 80th Hospital, Weifang, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.,Bioinspired Engineering and Biomechanics Center (BEBC), The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yi-Bo Xu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Li-Ping Xu
- Orthopaedics Institute of Chinese PLA, 80th Hospital, Weifang, China
| | - Zhe Song
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Shan Fan
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Han-Zhong Xue
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - De-Yin Liu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
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Lamas C, Grau A, Almenara M, Trigo L. Coronal shear fractures of the capitellum and trochlea: interobserver variability in classifying the fracture and the need for a computed tomography scan for the correct surgical planning. JSES Int 2020; 5:314-319. [PMID: 33681856 PMCID: PMC7910734 DOI: 10.1016/j.jseint.2020.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background To determine interobserver agreement in the classification by X-rays and by computed tomography (CT) scan of the coronal shear fractures of the capitellum and trochlea as well as the agreement between these two tests. Methods Patients with coronal shear fractures of the capitellum who were managed at our center between January 2008 and December 2017 were included. This retrospective cohort study was carried out with the approval of the ethics committee of our institution (Nº: IIBSP-Cod-2019-02, Ref. 19/070). Clinical, radiographic, and elbow-specific outcomes, including the Mayo Elbow Performance Index, were evaluated. Three observers analyzed the preoperative X-rays from all the cases. Each one of them independently classified the fractures according to the Bryan and Morrey classification (with the modification of McKee et al). The interobserver agreement was calculated by Cohen kappa coefficient. The same methodology was used to analyze the CT scan. Thereafter, one single value was determined for each X-ray and CT scan, from the good interobserver agreements. Finally, the agreement between the global X-ray classification and the global CT scan classification was calculated using the agreement percentage and the Cohen kappa coefficient. Results There were 3 males and 6 females, with a mean age of 47 years (range, 18-83). The mean follow-up period was 18 months (12-40). The average Mayo Elbow Performance Index score was 85 (range, 65-100) points. The complications were nonunion in one patient (11 %), degenerative arthritis in 7 (78 %), joint step-off in 5 (55%), and heterotopic ossification in 7 (78%). The agreement analysis between the global X-ray classification and the global CT scan classification showed a 57.1% agreement, with a kappa coefficient of −0.167. These values imply the absence of agreement. Conclusion Our results demostrated that simple X-rays do not allow for the adequate interpretation of distal humeral coronal plane fractures. Although an acceptable interobserver agreement was found, there is no agreement when the same fractures were analyzed by CT scan. The authors routinely recommend CT scan to assess the extent of the fracture and perform surgical planning.
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Affiliation(s)
- Claudia Lamas
- Hand Unit and Upper Extremity, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Grau
- Hand Unit and Upper Extremity, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Almenara
- Hand Unit and Upper Extremity, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Trigo
- Hand Unit and Upper Extremity, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
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Demir MT, Ertan Birsel S, Salih M, Pirinçci Y, Birsel O, Kesmezacar H. Outcome after the surgical treatment of the Dubberley type B distal humeral capitellar and trochlear fractures with a buttress plate. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:364-371. [PMID: 32554364 DOI: 10.5152/j.aott.2020.20092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aimed to evaluate the functional outcomes of the surgical treatment performed with a buttress plate for the trochlear and distal capitellum fractures with posterior extension in the humerus. METHODS The data belonging to 6 female and 4 male patients with a mean age of 43.8±11.1 (34-72) years were retrospectively evaluated. The mean follow-up period was 59.6±38.79 (22-127) months. The trochlear extension and posterior comminution of the fractures were assessed through the initial X-rays and computerized tomography images. Ten patients were classified as Dubberley type B. All fractures were treated surgically, with open reduction and internal fixation using a lateral buttress plate, headless cannulated screws, and Kirschner (K)-wires. The passive flexion and extension exercises were initiated at the first postoperative day. The patients were evaluated clinically and radiographically at the final follow-up. The outcomes were quantified using the Mayo Elbow Performance Index (MEPI), visual analog scale (VAS) pain score, and the patient's opinion. RESULTS At the final follow-up, the mean elbow flexion was 137.5°±3° (132°-140°), extension was -17.9°±9.2° (10°-35°), pronation was 72.2°±2.6° (68°-75°), and supination was 78.9°±4.09 (72°-85°). The mean MEPI score was calculated as 95.5±5.98 (85-100). According to the MEPI score, 8 patients were evaluated as excellent and 2 as good. The mean VAS pain score was 0.8±1.03 (0-2). The subjective patient evaluation was recorded as excellent in 5 patients, good in 3 patients, and moderate in 2 patients. One patient developed avascular necrosis and 2 patients had elbow joint arthrosis. K-wire migration was observed in one patient. Loss of reduction, nonunion, malunion, reflex sympathetic dystrophy, or heterotopic ossification were not encountered. CONCLUSION The management of distal humeral fractures is challenging, and favorable outcomes are closely associated with early joint motion. A solid fixation grants early mobilization. An internal fixation using lateral buttress plate, headless cannulated screws, and interfragmentary K-wires provides a solid and secure construction that allows early postoperative joint motion. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Muhammed Taha Demir
- Clinic of Orthopaedics and Traumatology, İstanbul Medicine Hospital, İstanbul, Turkey
| | - Sema Ertan Birsel
- Clinic of Orthopaedics and Traumatology, İstanbul Medicine Hospital, İstanbul, Turkey
| | - Muhammet Salih
- Clinic of Orthopaedics and Traumatology, İstanbul Medicine Hospital, İstanbul, Turkey
| | - Yusuf Pirinçci
- Clinic of Orthopaedics and Traumatology, İstanbul Medicine Hospital, İstanbul, Turkey
| | - Olgar Birsel
- Department of Orthopaedics and Traumatology, Koç University, School of Medicine, İstanbul, Turkey
| | - Hayrettin Kesmezacar
- Clinic of Orthopaedics and Traumatology, Florence Nightingale Hospital, İstanbul, Turkey
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Capitellum fractures: Treatment with headless screws and outcomes. Jt Dis Relat Surg 2020; 31:291-297. [PMID: 32584728 PMCID: PMC7489174 DOI: 10.5606/ehc.2020.72821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/08/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to present the results of 21 patients with capitellum fractures treated with open reduction and headless screws by a single experienced surgeon. Patients and methods
Twenty-one patients (13 males, 8 females; mean age 39 years; range, 18 to 63 years) who were admitted to our clinic between June 2011 and January 2018 with the diagnosis of capitellum fracture and followed-up for a mean period of 45 months (range, 12 to 90 months) were included in this retrospective study. The fractures were fixed with headless cannulated screws by a single surgeon. Results
The mean range of motion was 102° (range, 65° to 140°) during flexion-extension and 165° (range, 130° to 180°) during supination-pronation. The mean preoperative visual analog scale (VAS) score was 8.5 (range, 6 to 10), whereas the mean postoperative VAS score was 2.2 (range, 0 to 6). According to the Mayo Elbow Performance score, nine patients were evaluated as excellent, six patients as good, four patients as fair, and two as poor. The mean Quick-Disabilities of the Arm, Shoulder and Hand score was 25.1 (range, 4 to 57). Avascular necrosis developed in three patients (14%) and heterotopic ossification was detected in one patient (4%). Conclusion Capitellum fractures are difficult to diagnose and treat, and good results can only be achieved by an accurate diagnosis, careful surgical technique, and stable fixation. Larger and more comprehensive studies are required to establish a generalization and more accurate inferences on this limitedly studied subject.
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Watson JJ, Bellringer S, Phadnis J. Coronal shear fractures of the distal humerus: Current concepts and surgical techniques. Shoulder Elbow 2020; 12:124-135. [PMID: 32313562 PMCID: PMC7153208 DOI: 10.1177/1758573219826529] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/07/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022]
Abstract
Coronal shear fractures of the distal humerus are a unique subset of distal humeral fractures which entail partial or complete articular fractures of the distal humerus without involvement of the columns. The very distal nature of these fragments, their small size and propensity for comminution render them challenging to treat surgically. The purpose of this article is to describe the classification, outcomes and surgical techniques currently used for the treatment of these fractures using the available literature and authors' clinical experience.
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Affiliation(s)
| | | | - Joideep Phadnis
- J Phadnis, Montefiore hospital, Montefiore Road, Hove, BN3 1RD, UK.
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The anterior limited approach of the elbow for the treatment of capitellum and trochlea fractures: Surgical technique and clinical experience in eight cases. Injury 2020; 51 Suppl 1:S103-S111. [PMID: 32063337 DOI: 10.1016/j.injury.2020.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
When a coronal fracture affects the capitellum and the trochlea, the Kocher lateral approach may be inadequate for the correct visualisation, reduction and fixation of the fracture. In such cases an associated medial elbow approach may be required, or a posterior transolecranon approach may be preferred. The anterior limited approach to the elbow (ALAE) could be a valid option when treating these types of fracture, as it does not involve the detachment of any muscle group or ligament, thereby facilitating the recovery process. We can also treat associated injuries such as fractures of the radial head or coronoid process with this approach. We describe the surgical technique and the functional outcome of eight patients with a mean of 66 years of age (range, 53-76) who where treated with open reduction and internal fixation for capitellar and trochlear fractures through the ALAE. Patient outcomes were assessed with physical and radiological evaluation, range-of-motion measurements with a follow-up from 24 to 60 months. Two different quality of life questionnaires were carried out: the EuroQol Five Dimensions Questionnaire (EQ-5D) and the patient-answered questionnnaire of the Liverpool Elbow Score patient (PAQ-LES). Four fractures involved the capitellum, one involved the capitellum with the lateral ridge of the trochlea, and three involved the capitellum and trochlea as separate fragments. The patients presented a favorable clinical evolution at a median of 33 months (range, 24-60), with an average of motion of 10-138°. Four patients presented a fracture of the head of the radius (Mason type 2) and 3 fractures of the coronoid (Bryan-Morrey Type 1) associated. All the patients presented radiological consolidation without signs of osteonecrosis, being the average EQ-5D 0.857 (range, 0.36-1.0) and the PAQ-LES of 35 (range 17 to 36). Patients with isolated capitellar fractures had better results than those with trochlear involvement. The presence of associated fractures does not seem to worsen the results. We believe that the ALAE is a technical option to consider for the open surgical treatment of a capitellar fracture with or without involvement of the trochlea. LEVEL OF EVIDENCEIS: Therapeutic Level III.
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Lauder A, Richard MJ. Management of distal humerus fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:745-762. [DOI: 10.1007/s00590-020-02626-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
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Song Z, Wang Q, Ma T, Wang C, Yang N, Xue H, Li Z, Zhu Y, Zhang K. Anti-sliding plate technique for coronal shear fractures of the distal humerus. J Orthop Surg Res 2020; 15:18. [PMID: 31952529 PMCID: PMC6969457 DOI: 10.1186/s13018-019-1466-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/08/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The purpose of this study is to discuss the surgical strategy, technical feasibility, and clinical efficacy of coronal shear fractures of the distal humerus using the anti-sliding plate technique. METHODS Fifty-two patients (35 males and 17 females) were treated with the anti-sliding plate technique in our hospital from January 2012 to January 2017. The average age of the patients was 40.4 years. They were classified according to the Dubberley classification system and treated with the anti-sliding plate technique. The long-term functional scores represented by the Mayo Elbow Performance Index and complications were evaluated. RESULTS Fractures were classified as follows: 11 type-IA, 5 type-IB, 16 type-IIA, 4 type-IIB, 13 type-IIIA, and 3 type-IIIB according to the Dubberley classification system. All patients were treated with open reduction and internal fixation by the extensile lateral approach and completed a clinical and radiographic follow-up (average, 17.6 months). The average Mayo elbow performance score was 90.6 points, with 36 excellent, 11 good, and 5 fair results. The average range of movement of the elbow joint was 3° (0-15°) for extension and 136° (90-150°) for flexion. CONCLUSIONS The anti-sliding plate technique follows basic AO principles and neutralizes the shearing force combined with lag screws and/or Kirschner wires after the anatomic reduction of the fracture. It allows for the stable internal fixation of the fracture, which is critical for early mobilization and a good functional outcome. LEVEL OF EVIDENCE Level IV, Case Series, Treatment Study.
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Affiliation(s)
- Zhe Song
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Qian Wang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Teng Ma
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Chen Wang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Na Yang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Hanzhong Xue
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Zhong Li
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Yangjun Zhu
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China.
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Yu T, Tao H, Xu F, Hu Y, Zhang C, Zhou G. Comparison of lateral approach versus anterolateral approach with Herbert screw fixation for isolated coronal shear fractures of humeral capitellum. J Orthop Surg Res 2019; 14:230. [PMID: 31331352 PMCID: PMC6647071 DOI: 10.1186/s13018-019-1261-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/04/2019] [Indexed: 01/26/2023] Open
Abstract
Background For coronal shear fractures of humeral capitellum, the lateral approach is the most commonly used surgical approach. However, exposure range of the anterior aspect of the distal humerus is inadequate. The anterolateral approach has also been adopted to overcome this disadvantage. However, this approach seems anatomically complex due to the risk of iatrogenic injury to the radial nerve. So far, the optimal approach for the treatment of capitellar shear fractures remains inconclusive. The purpose of this study is to prospectively review and compare the early clinical and radiographic outcomes of treated with open reduction and Herbert screw internal fixation through the lateral approach or the anterolateral approach. Methods Twenty-six patients with isolated capitellar shear fractures were enrolled from January 2013 to December 2017, and randomly assigned to lateral approach group or anterolateral approach group. All the fractures were treated with open reduction and Herbert screw internal fixation through lateral approach or anterolateral approach. Operation time, wound healing complication, elbow joint function, and radiographic evidence were evaluated and compared between two groups. Results The operation via the anterolateral approach took significantly shorter time than via lateral approach (p < 0.05). There were no wound healing problems and infection for both groups. One patient from anterolateral approach group sustained incomplete posterior interosseous nerve palsy, which recovered completely in 4 weeks without residual compromise. All fractures healed well in their normal anatomic position as seen on radiographs. At the final follow-up, no significant difference was found between two groups with respect to the ROM in supination-pronation, ROM in pronation-supination, loss of flexion-extension motion, or loss of pronation-supination motion (p > 0.05). There is no significant difference with respect to MEPI score of elbow joint between two groups (p > 0.05). Conclusion Based on our findings, both lateral approach and anterolateral approach with Herbert screw internal fixation are suitable for coronal shear fractures of capitellum with satisfactory early outcomes. Compared with the lateral approach, the anterolateral approach made the surgical procedure easier and time saving in current series. When the medial aspect of the trochlea is involved for capitellar coronal fractures, the anterolateral lateral approach should be preferred.
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Affiliation(s)
- Tengbo Yu
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China
| | - Hao Tao
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China
| | - Fenglei Xu
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
| | - Yanling Hu
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China.
| | - Chengdong Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China
| | - Guangjie Zhou
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China
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Treatment of capitellar and trochlear fractures with posterior comminution: minimum 2-year follow-up. J Shoulder Elbow Surg 2019; 28:931-938. [PMID: 30595502 DOI: 10.1016/j.jse.2018.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS This study aimed to evaluate the safety and efficacy of the fixation of Dubberley type B capitellar and trochlear fractures using dorsolateral anatomic plates with support of the distal humerus (DAPSDHs). METHODS Fifteen patients with Dubberley type B capitellar and trochlear fractures (two type 1B, five type 2B, and eight type 3B) were treated through the extended lateral approach, and fixation was achieved with DAPSDHs. Radiographic evaluation was performed, and range of motion of the elbow and forearm was recorded. Functional outcomes were assessed using the Mayo Elbow Performance Score and Disabilities of the Arm, Shoulder and Hand score. RESULTS The mean follow-up period was 32.5 months (range, 24-54 months). Fracture union was achieved in all cases. At the final follow-up, range of motion was as follows: flexion, 123.7° ± 8.1° (range, 110°-135°); lack of extension, 11.0° ± 7.1° (range, 5°-30°); pronation, 81.7° ± 5.6° (range, 70°-90°); and supination, 78.7° ± 5.2° (range, 70°-85°). At the final follow-up, the mean Disabilities of the Arm, Shoulder and Hand score was 11.9 ± 4.0 (range, 4.2-20.8) and the mean Mayo Elbow Performance Score was 89.0 ± 7.1 (range, 70-95). The outcome was rated as excellent in 12 patients (80.0%), good in 2 (13.3%), and fair in 1 (6.7%). Avascular necrosis of the capitellum developed in 1 patient. One patient had implant irritation. Heterotopic ossification developed in 1 patient. Ten patients returned to their previous activity levels. CONCLUSION Capitellar and trochlear fractures with posterior comminution are safely and effectively treated through the extended lateral approach using DAPSDHs, resulting in good radiographic and functional outcomes.
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He SK, Zhao SC, Guo JH, Qin TW, Huang FG. Combined use of Kirschner wires and hinged external fixator for capitellar and trochlear fractures: a minimum 24-month follow-up. ANZ J Surg 2018; 89:196-200. [PMID: 30484942 DOI: 10.1111/ans.14924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/19/2018] [Accepted: 09/22/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Open reduction and internal fixation is the adequate treatment for capitellar and trochlear fractures. Given the low incidence of this type of fractures, it is difficult to constitute a universally accepted method for fixation. Thus, we hypothesised that combined use of Kirschner wires (K-wires), absorbable rods and sutures for fixation and post-operative hinged external fixator for early rehabilitation exercise can restore elbow joint function well. METHODS This retrospective study included 20 patients with a mean age of 48.3 (range 16-76) years. According to the Dubberley classification, fractures were classified on plain radiographs, computed tomography images and intra-operative findings. All patients were evaluated by the range of motion of the elbow and the Broberg-Morrey score. RESULTS All fractures had healed without non-union, and the average time was 13.6 (range 8-17) weeks. The mean follow-up was 42.5 (range 24-80) months. The mean flexion was 117.1° (range 90°-135°), and the mean extension was 17.5° (range 0°-45°). The mean pronation was 74.4° (range 45°-85°), and the mean supination was 84.3° (range 60°-90°). The average Broberg-Morrey score was 86.2 (range 68-98) points with 10 excellent, 7 good and 3 fair results. CONCLUSION K-wires, absorbable rods and sutures combined with hinged external fixator are feasible for fixation of capitellar and trochlear fractures. However, due to the absence of a control group (such as Herbert screw fixation), comparative studies are still needed to demonstrate the safety and reliability of K-wires for fixation.
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Affiliation(s)
- Shu-Kun He
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Si-Chun Zhao
- Department of Orthopedics, The Third People's Hospital of Mianyang, Mianyang, China
| | - Jin-Hai Guo
- Department of Orthopedics, The First People's Hospital of Jintang County (The Jintang Hospital of West China Hospital, Sichuan University), Chengdu, China
| | - Ting-Wu Qin
- Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Fu-Guo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Does the presence of posterior comminution modify the treatment and prognosis in capitellar and trochlear fractures? Study performed on 45 consecutive patients. Injury 2018; 49 Suppl 3:S84-S93. [PMID: 30415675 DOI: 10.1016/j.injury.2018.09.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Only few case series of capitellar and trochlear fractures have been reported. Some of them assume that the presence of a posterior comminution (type B according to Dubberley classification) can represent a negative risk factor for treatment and prognosis respect to the type A cases (without posterior comminution). Nevertheless, how this parameter impacts the treatment and the prognosis has never been quantified before. MATERIALS AND METHODS All the capitellar and trochlear fractures treated from 2007 to 2015 have been retrospectively reviewed. The presence of posterior comminution on a pre-operative CT-scan was correlated to the surgical technique, to the timing of initiation of rehabilitation and to clinical outcomes. RESULTS 45 Consecutive patients have been selected, 17 not presenting a posterior comminution (type A), and 28 with posterior comminution (type B). In all the type A fractures a lateral approach (Kocher o Kocher extensile) was used and the fragment fixation was always performed using only screws. Elbow replacement or olecranon osteotomy were performed only to treat type B fractures. Augmented fixations, using plates and k-wires, or prosthetic replacement have been used only in type B fractures. The post-operative immobilization was significantly inferior for type A fracture. Better results have been obtained in type A fractures: mean MEPI score was 86 in type A and 73 in type B, the range of motion was significatively higher in type A both in flexion-extension and in pronation-supination. In type B fractures a significant higher number of complications have been observed (64% vs 29%) along with more reoperations. DISCUSSION The study has confirmed that, even without considering the extension of the fracture on the coronal plane, the presence of posterior comminution represents an evident negative risk factor, influencing the surgical approach and treatment, the fixation technique, the post-operative rehabilitation, the clinical outcomes, the complications and re-operation rates. CONCLUSIONS The analysis of the present case series shows how the treatment and the outcomes can be significantly anticipated based on the presence or absence of posterior comminution. Patients with type A fracture are more likely treated with a Kocher approach, screw fixation, an early rehabilitation is performed. In type A fractures better outcomes and low complications rate are expected.
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Mid-term and Long-term Functional and Radiographic Results of 13 Surgically Treated Adolescent Capitellum Fractures. J Pediatr Orthop 2018; 38:e424-e428. [PMID: 29917008 DOI: 10.1097/bpo.0000000000001208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Capitellum fractures are rare in adolescents, and information in literature is still limited. The purpose of this study was to report the mid-term and long-term functional and radiographic results of 13 surgically treated adolescent capitellum fractures in a level I trauma center. METHODS This retrospective study included patients aged 10 to 16 years, who underwent surgery for a capitellum fracture and were followed up for at least 12 months. Fractures were classified according to the McKee modification of the Bryan and Morrey classification, and elbow arthritis was classified using the Broberg and Morrey system. Functional outcomes were assessed with the Mayo Elbow Performance Index (MEPI) and the Turkish-language version of the shortened version of the Disabilities of Arm, Shoulder, and Hand (QuickDASH) scale. RESULTS The mean time to surgical intervention was 4.5 days (range, 1 to 18 d). The mean flexion-extension range of motion arc was measured as 115 (range, 45 to 150) degrees. The mean restriction for extension and flexion compared with the uninjured side was measured as 10.7 (range, 0 to 45) and 11.5 (range, 0 to 45) degrees, respectively. The mean MEPI was 87.7 points (range, 50 to 100 points) with 9 patients as excellent, 1 good, 1 fair, and 2 poor results. The mean QuickDASH score was 11 (range, 0 to 57). The mean MEPI score was 95.6 and 75 and the mean QuickDASH score was 2.62 and 25.0 for early surgery group (≤3 d) and late surgery group (>3 d), respectively (P=0.073, 0.024). Elbow joint contracture developed in 4 patients. Implant removal and open release of joint contracture was applied to 2 patients. Elbow arthritis of grade 3 was observed in 2 patients and grade 2 in 1 patient. CONCLUSIONS Capitellum fractures may be easily missed on conventional radiographs, if not suspected. Delayed diagnosis may lead to a worsening of the functional outcomes. Computerized tomography is helpful in the determination of these fractures. Early diagnosis and a well-performed surgery is essential for successful outcome. LEVEL OF EVIDENCE Level IV-case series.
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The impact of associated injuries and fracture classifications on the treatment of capitellum and trochlea fractures: A systematic review and meta-analysis. Int J Surg 2018; 54:37-47. [PMID: 29684669 DOI: 10.1016/j.ijsu.2018.04.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/26/2018] [Accepted: 04/13/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Capitellum and trochlea fractures are truly rare and the treatment is not fully appreciated. So we evaluate the impact of associated injuries and fracture classifications on elbow functional outcomes after open reduction and internal fixation. MATERIALS AND METHODS PubMed, Embase, Ovid Medline, and the Cochrane Library were searched from January 1, 1974 to January 1, 2017. All English literature with the treatment of capitellum and trochlea fractures by open reduction and internal fixation were included. RESULTS For associated injuries, the results suggested that the MEPI score of patients without associated injuries was higher than that of patients with associated injuries (P = 0.001). However, there was no significant difference in the arc of motion between the two groups (P = 0.052). For Bryan and Morrey classification, there was no significant difference in the MEPI score (P = 0.622) and in the arc of motion (P = 0.652) between type-I fractures and type-IV fractures. For Dubberley classification, there was significant difference only in the MEPI score between subtype-A fractures and subtype-B fractures (P = 0.005). CONCLUSION The associated injury of fracture may have a negative impact on the functional outcomes of elbow. And Dubberley classification is more suitable to classify this kind of fracture. Furthermore, high-quality studies are required to attain robust evidence.
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Yu T, Tao H, Xu F, Hu Y, Zhang C, Zhou G. Management of isolated coronal shear fractures of the humeral capitellum with Herbert screw fixation through anterolateral approach. BMC Musculoskelet Disord 2018; 19:108. [PMID: 29621984 PMCID: PMC5887211 DOI: 10.1186/s12891-018-2024-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/23/2018] [Indexed: 01/30/2023] Open
Abstract
Background Due to the intraarticular and complex nature of the coronal shear fracture of the humeral capitellum and its rarity, it has been difficult to formulate a universally accepted method of surgical management. The purpose of this study is to retrospectively evaluate the clinical outcomes of 15 patients with isolated coronal shear fractures of the capitellum treated by Herbert screw fixation through anterolateral approach, and to address the safety and tips for this surgical procedure. Methods This retrospective study included 15 isolated coronal shear fractures of the capitellum without posterior involvement, which were classified according to the Dubberley classification as 11 type 1A fractures and 4 type 3A fractures. All fractures were treated with Herbert screws fixation via the anterolateral approach. Clinical and radiographic evaluation was performed regularly, with a mean follow-up of 29 months. Results The mean operative time was 81 min. There were no wound healing problems or infection. One incomplete posterior interosseous nerve injury occurred, which recovered soon without residual compromise. All fractures healed well. At the final follow-up, the average range of motion was 134°in flexion-extension and 172°in supination-pronation. There was no significant difference between the affected and the unaffected elbows with regard to motion in flexion-extension or flexion-extension. The average Mayo Elbow Performance Index Score was 93 with 11 excellent and 4 good. No evidence of avascular necrosis, posttraumatic osteoarthritis, or heterotrophic ossification was found. Conclusion Open reduction and internal fixation using Herbert screws through a anterolateral approach is a reliable and effective treatment for coronal shear fractures of capitellum, and able to achieve stable fixation and restoration of a functional range of motion.
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Affiliation(s)
- Tengbo Yu
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
| | - Hao Tao
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
| | - Fenglei Xu
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
| | - Yanling Hu
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China. .,Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao City, 266003, Shandong Province, China.
| | - Chengdong Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
| | - Guangjie Zhou
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
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Tanwar YS, Kharbanda Y, Jaiswal A, Birla V, Pandit R. Retrospective analysis of open reduction and internal fixation of coronal plane fractures of the capitellum and trochlea using the anterolateral approach. SICOT J 2018; 4:8. [PMID: 29547117 PMCID: PMC5855499 DOI: 10.1051/sicotj/2017063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/15/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction: Coronal plane distal humeral injuries are relatively rare. Numerous classification systems have been proposed as the complexity of these fractures has been realized. We in the present series of ten patients describe the surgical technique of Open Reduction and Internal Fixation of Coronal plane fractures of the distal humerus with headless compression screws performed using the anterolateral approach. Material and method: It was a retrospective study, the data collected from March 2010 to 2015 was analysed and the final outcome was assessed using the DASH score. Out of a total of 13 patients with distal humerus coronal plane fractures, 10 patients were available for follow up. The X-rays and CT scans were reviewed and the fractures were classified according to Dubberley and Bryan and Morrey classification. Radiographic were evaluated for presence of union or nonunion, avascular necrosis, joint line step-off (none/1-mm/>1-mm), hardware failure and instability. Results: The average age was 41 years. The average DASH score in our study was around 24. The time to union ranged between 8–12 weeks with the average time being around 10 weeks. One patient had post traumatic Arthritis radiologically classified as Broberg and Morrey Type 2 and one patient had Heterotrophic ossification Brooker Grade 1. Conclusion: Open reduction and internal fixation of coronal shear fractures of capitellum and trochlea using headless screw compression via the antero-lateral approach is a reliable treatment modality and results in stable fixation with restoration of a functional arc of motion. Level of evidence: IV
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Affiliation(s)
| | - Yatinder Kharbanda
- Department of Orthopedics, Apollo Hospital, Sarita Vihar, Delhi 110076, India
| | - Atin Jaiswal
- Maya Hospital, Farrukhabad, Uttar Pradesh, India
| | - Vikas Birla
- Department of Orthopedics, Apollo Hospital, Sarita Vihar, Delhi 110076, India
| | - Ramsagar Pandit
- Department of Orthopedics, Apollo Hospital, Sarita Vihar, Delhi 110076, India
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Schmidt I. A Complicated Course of a Coronal Shear Fracture Type IV of the Distal Part of Humerus Resulting in Resurfacing Radiocapitellar Joint Replacement. Open Orthop J 2017; 11:248-254. [PMID: 28567152 PMCID: PMC5420185 DOI: 10.2174/1874325001711010248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Coronal shear fracture type IV of the distal part of humerus is a very rare injury with articular complexity potentially leading to posttraumatic osteoarthritis. One option for surgical treatment of advanced unicompartmental radiocapitellar osteoarthritis is resurfacing radiocapitellar joint replacement. Method: A 62-year- old female sustained a coronal shear fracture type IV of the distal part of left humerus that was primarily treated with open reduction and internal fixation using headless compression screws. Three years postoperatively, there was a migration of one screw into radiocapitellar joint that led to circular deep cartilage defect of radial head. Four years after ORIF, a distinctive radiocapitellar osteoarthritis has evolved leading to a resurfacing radiocapitellar joint replacement using the Lateral Resurfacing ElbowTM (LRE) system. Result: At the 2-year follow-up after that procedure, there was an excellent subjective and functional outcome. Radiographically, no loosening or subsidence of implant without any signs of overstuffing could be found. The patient reported that she would have the same procedure again. Conclusion: The goal of unicompartmental radiocapitellar replacement is to obtain stability in elbow joint by avoiding cubitus valgus with subsequent instability of the distal radioulnar joint, and it does not alter the unaffected ulnohumeral joint. Additionally, the feature of the LRETM system is that the radial head is not excised, and so will receive the anatomical length of the overall radius articulating with the capitellum by preserving the annular ligament. In the literature only three publications could be found in which short-term results with the use of the LRETM system have been described. Hence, further studies are needed to validate this concept.
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Affiliation(s)
- Ingo Schmidt
- SRH Poliklinik Gera Gmbh, Straße des Friedens 122, Gera 07548, Germany
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Ballesteros-Betancourt J, Fernández-Valencia J, García-Tarriño R, Domingo-Trepat A, Sastre-Solsona S, Combalia-Aleu A, Llusá-Pérez M. The limited anterior approach of the elbow for open reduction and internal fixation of capitellum fractures. Surgical technique and clinical experience in 2 cases with more than 2 years follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ballesteros-Betancourt JR, Fernández-Valencia JA, García-Tarriño R, Domingo-Trepat A, Sastre-Solsona S, Combalia-Aleu A, Llusá-Pérez M. The limited anterior approach of the elbow for open reduction and internal fixation of capitellum fractures. Surgical technique and clinical experience in 2 cases with more than 2 years follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:176-184. [PMID: 28373087 DOI: 10.1016/j.recot.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/13/2017] [Accepted: 02/12/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Fractures involving the capitellum can be treated surgically by excision of the fragment, or by reduction and internal fixation with screws, with or without heads. The lateral Kocher approach is the most common approach for open reduction. We believe that the limited anterior approach of the elbow, could be a valid technique for treating these fractures, as it does not involve the detachment of any muscle group or ligament, facilitating the recovery process. MATERIAL AND METHOD A description is presented of the surgical technique, as well as of 2cases with a Bryan-Morrey type 1 fracture (Dubberley type 1A). Two different final quality of life evaluation questionnaires were completed by telephone: the EuroQol Five Dimensions Questionnaire (EQ-5D), and the patient part of the Liverpool Elbow Score (PAQ-LES) questionnaire. RESULTS The 2patients showed favourable clinical progress at 36 and 24 months, respectively, with an extension/flexion movement arc of -5°/145° and -10°/145°, as well as a pronosupination of 85°/80° and 90°/90°. The 2patients showed radiological consolidation with no signs of osteonecrosis. The EQ-5D score was 0.857 and 0.910 (range: 0.36-1), and a PAQ-SLE of 35 and 35 (range: 17-36), respectively. CONCLUSIONS We believe that the limited anterior approach of the elbow is a technical option to consider for the open surgical treatment of a capitellum fracture, although further studies are needed to demonstrate its superiority and clinical safety compared to the classical lateral Kocher approach.
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Affiliation(s)
- J R Ballesteros-Betancourt
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España; Departamento Anatomía Humana y Embriología, Facultad de Medicina. Universidad de Barcelona, Barcelona, España.
| | - J A Fernández-Valencia
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España
| | - R García-Tarriño
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España
| | - A Domingo-Trepat
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España
| | - S Sastre-Solsona
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España
| | - A Combalia-Aleu
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España
| | - M Llusá-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España
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Ravishankar MR, Kumar MN, Raut R. Choice of surgical approach for capitellar fractures based on pathoanatomy of fractures: outcomes of surgical management. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:233-242. [DOI: 10.1007/s00590-016-1877-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/22/2016] [Indexed: 01/02/2023]
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Tobert DG, Klausmeyer M, Mudgal CS. Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws. J Hand Microsurg 2016; 8:134-139. [PMID: 27999455 DOI: 10.1055/s-0036-1593390] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022] Open
Abstract
Introduction The purpose of this study is to examine the clinical results of retrograde intramedullary headless screw (IMHS) fixation for metacarpal fractures. Methods A retrospective review was performed on 16 patients with 18 metacarpal fractures who underwent IMHS fixation at a single institution. The average age was 32 years. The indications for surgery included rotational malalignment (five patients), multiple metacarpal fractures (five patients), angular deformity (four patients), and shortening greater than 5 mm (two patients). The average length of follow-up was 19.4 weeks (median 10.2 weeks). Results Functional outcome was considered excellent in all patients with total active motion in excess of 240 degrees. Active motion was initiated within 1 week of surgery. No secondary surgeries were performed related to a complication of IMHS fixation. Conclusion IMHS fixation of metacarpal fractures is an efficacious treatment modality for patients with comminution, multiple fractures, malrotation, and those who require rapid mobilization. It obviates the need for immobilization or more extensive plate and screw fixation techniques with excellent clinical results.
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Affiliation(s)
- Daniel G Tobert
- Department of Orthopaedic Surgery, Orthopaedic Hand Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States; Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Melissa Klausmeyer
- Department of Plastic Surgery, University of Southern California, Los Angeles, California, United States
| | - Chaitanya S Mudgal
- Department of Orthopaedic Surgery, Orthopaedic Hand Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Are A, Tornatore I, Theodorakis E. Operative management of a shear fracture of the bilateral capitellum: A case report and review of the literature. Chin J Traumatol 2016; 19:231-4. [PMID: 27578382 PMCID: PMC4992124 DOI: 10.1016/j.cjtee.2015.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Fracture of bilateral capitulum humeri is a very rare injury. We present a case of a 38-year-old woman, affected by a shear fracture of bilateral capitellum after a motorcycle accident. Intervention was carried out through a lateral approach on both sides and direct fixation of the fragment with headless screws. Consolidation was achieved and no signs of avascular necrosis occurred at 24 months of follow-up. The patient returned to her previous activities with no functional limitations. To the best of our knowledge, only four cases are reported describing different types of treatment and postoperative period of cast immobilization. According to our review of the literature regarding capitellar fractures, we preferred an immediate postoperative rehabilitation of the elbow, following the stable osteosynthesis.
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Affiliation(s)
- Alessandro Are
- Department of Orthopedics, Policlinico Casilino Hospital, Rome, Italy
| | - Ignazio Tornatore
- Department of Orthopedics, Policlinico Casilino Hospital, Rome, Italy
| | - Emmanouil Theodorakis
- Department of Orthopedics, Aurelia Hospital, Rome, Italy,Corresponding author. Tel.: +39 3407444861.
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Clinical outcome and osteoarthritic changes after surgical treatment of isolated capitulum humeri fractures with a minimum follow-up of five years. INTERNATIONAL ORTHOPAEDICS 2016; 40:2603-2610. [PMID: 27040553 DOI: 10.1007/s00264-016-3165-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/06/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of this study was to evaluate the functional outcome of patients treated for a fracture of the capitulum humeri and to analyze the grade of osteoarthritic changes. METHODS Patients undergoing surgical reconstruction of isolated capitulum humeri fractures were included in a retrospective comparative analysis. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) and Dubberley and were functionally evaluated by the American Shoulder and Elbow Surgeons Score (ASES) and the Mayo Elbow Performance Index (MEPI). Levels of arthritic changes were measured with the Broberg and Morrey Score. Frequency of complications was evaluated whereby all results were compared to the ipsilateral, unaffected side. RESULTS Thirteen patients, ten females (76.9 %) and three males (23.1 %), with a mean age of 48.7 ± 13.3 years were included in the study. Long-term follow-up range of motion (ROM) in the sagittal plane was significantly influenced by time of surgery (p < 0.001), and long-term follow-up with respect to pronation and supination by ROM of the healthy control (p < 0.05). The average ASES score was 37.8, and the Mayo Elbow Performance Index (MEPI) was 92.7. The mean level of degenerative arthritic changes was 1.9 ± 0.6 on the fractured side and significantly less (0.8 ± 0.8) on the healthy side (pF-test < 0.001). At a mean follow-up of 118.5 ± 52.4 months neither nonunion nor avascular necrosis were observed in any case. However, six cases of heterotopic ossification were identified. CONCLUSIONS Satisfying functional outcomes and a low rate of osteoarthritic changes can be expected after the presented open reduction and internal fixation of capitulum humeri fractures. LEVEL OF EVIDENCE Level IV - Case series; therapeutic study.
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