Fracture of the capitellum

Fracture of the capitellum

• 1.
  Fracture of theCapitellum Dr. Ashiqur Rahman Resident Orthopedics Dhaka Medical college Hospital
• 2.
  Introduction  This isa rare articular fracture that is usually more extensive than it initially appear.  It may involve trochlea & posterior humeral head.
• 3.
  Clinical features - Theelbow is held at 70° flexion as this is the most relaxed position of the joint capsule accommodating the hemarthrosis. - The lateral side of the elbow is tender. - Bruising on the lateral side may indicate disruption of the superficial fascia & more significant soft tissue injury.
• 4.
  Imaging - Xray :(i) The capitellum is displaced such that the radial head is no longer articulates congruently with it, often rotate 90° to face the shoulder. (ii) A double arc sign (Two crescent shapes on the lateral view) indicates # extends into the trochlea. - CT scan : May be helpful in clarifying the diagnosis & extent of the injury.
• 6.
  Classification of Capitellum#(Bryan & Morrey) 1. Type – I : Complete simple fracture 2. Type – II : Cartilaginous sell 3. Type – III : Comminuted fracture
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  Treatment 1. Undisplaced fracture: - are rare, can be treated with analgesia & collar & cuff.
• 8.
  2. Displaced fracture: - Can be reduced & held. - While close reduction is feasible, prolong immobilization may result in a stiff elbow & therefore ORIF is preferred. - If there is no dorsal comminution, a good quality bone, one or two head less screws or lag screws can be passed from anterior to posterior to stabilize the fragments.
• 9.
  - If thereis comminution, a dorsal plate can be used with or without a block bone graft, depending on the amount of bone loss. - Highly comminuted # have to be excised. - Movements are commenced as soon as possible. - Injury to the lateral ligament complex must be addressed acutely.
• 10.
  Head less screwfixation
• 12.
  Dorsal plating for# Capitellum & Trochlea