Capitellum Fractures

Like fractures of the trochlea, fractures of the capitellum are quite rare. The mechanism of injury occurs as a result of breaking a fall with the outstretched hand with the elbow in flexion or direct trauma to the elbow that is in full flexion. Three types of fractures are recognized: type I is a shearing of the capitellum from the lateral column, type II an osteochondral fracture of the anterior capitellum, and type III a comminuted or impacted fracture. Physical findings include tenderness and swelling laterally and limitation of ROM. Limitation of movement is due to mechanical obstruction from the fracture fragment in flexion or extension. Clinical as well as radiographic evaluation is also directed at determining associated injuries, especially a radial head fracture. Standard radiographs are generally sufficient to evaluate the injury. Special attention must be directed at the radiographs, since the fracture fragment consists largely of cartilage that will not be easily recognized, especially against the background of the humerus. The lateral radiograph may reveal the fragment anterior and proximal to its usual anatomic position.

Undisplaced fractures are initially treated in a long-arm splint with the elbow flexed to 90° and the forearm neutral. Although a recent paper described closed reduction for displaced fractures, most authors recommend open reduction and fixation with screws or Kirschner (K) wires.

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