Anterior approach of the elbow for fixation of capitulum fractures

Abstract

Objective: Fractures involving the capitellum can be treated surgically by excision of the fragment, or by reduction and internal fixation with headless screws. The lateral Kocher approach is the most common approach for open reduction. We believe that the 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: 4 Patients with capitulum fracture admitted in NCH-Surat. As a primary treatment above elbow splint applied. X-ray and CT scan was done. Patient was operated via anterior approach and fracture was fixed with Herbert screws. Exposure, intraoperative blood loss, duration of surgery and any significant intraoperative events if any are noted. Stitches was removed on 12th post operative day and elbow mobilized according to fixation. Patient was followed up till 6 months and clinical and radiological examination was done. Results: Anterior approach to capitulum provide good exposure. The patients showed favourable clinical progress at 6 months, respectively, with a mean extension/flexion movement arc of 0 to135o. The patients showed radiological consolidation with no signs of osteonecrosis. Conclusions: We believe that the 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.