Fracture of the capitellum

Simplification fracture of capitellum. All information have been taken from authentic sources.

1. Fracture of the Capitellum Dr. Ashiqur Rahman Resident Orthopedics Dhaka Medical college Hospital

2. Introduction This is a rare articular fracture that is usually more extensive than it initially appear. It may involve trochlea & posterior humeral head.

3. Clinical features - The elbow 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.

5. Classification of Capitellum #(Bryan & Morrey) Type – I : Complete simple fracture Type – II : Cartilaginous sell Type – III : Comminuted fracture

6. Treatment Undisplaced fracture : - are rare, can be treated with analgesia & collar & cuff.

7. 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.

8. - If there is 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.

9. Head less screw fixation

10. Dorsal plating for # Capitellum & Trochlea