Functional outcome of capitulum fracture by open reduction internal fixation with herbert screws

Abstract

Background: Fractures of the capitellum are rare injuries of the elbow usually seen in the adolescents. This fracture is often missed in the emergency room if a proper radiograph is not available. Recent reports have described many modalities of treatment favoring headless screw for fixation. The facility for headless screw fixation, however, is not available in most centers. This paper presents the diagnosis and management of type 4 capitellar fractures (Mckee) with gadgets available in a district hospital. Introduction: 12 patients with capitellar fractures were included in this retrospective study. A well taken lateral radiograph was important and stressed upon in all patients. All fractures were open reduced and internally fixed using Herbert screws via an extensile lateral approach over a period of 2 years. Clinical, radiographic, and Mayo Elbow Performance Index were evaluated at a mean follow-up of 2years (1.5 to 2years) Results: Nine type I and three type IV capitellar fractures were identified using Bryan and Morrey classification system. The average time to bone union was 14 weeks (range 8-16 weeks) with no case of nonunion. The mean range of flexion was 130° (range 125°-135°). The average extensor lag was 10° (range 0°-30°), with a functional range of motion of elbow achieved in all patients. On the final follow-up, one case of osteoarthritis was seen, but no evidence of avascular necrosis or heterotrophic ossification was seen. Two patients needed screw removal. The outcome was excellent in 10 patients and good in two patients Conclusion: Double arc sign on lateral X-rays of the elbow along with pre-operative CT scan evaluation is important to avoid a missed diagnosis and analysis of type IV capitellur fracture. Fixation with non-cannulated ordinary Herbert screws using extended Kocher's lateral approach has given good results.