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Capitelar and Coronal Shear Frx


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- Discussion:
    - see lateral condyle fracture
- uncommon frx which is difficult to diagnose if fracture frag is small;
- any effussion within the elbow joint together with displacement of fat pads suggests either a capitulum fracture or
nondisplaced frx of radial head;

- Type I: (Hans Steinthal Frx)
- type I is fracture of the capitullum in the coronal plane;
- involes large part of the osseous portion of capitulum, w/ little or no involvement into the lateral aspect of the trochlea;
- frx hinges anteriorly between radial head and radial fossa producing a block to flexion;
- frx involves most of the anterior articular surface of the capitellum and the trochlea;
- often results from a fall from a height;
- radiographs:
            - double arc sign seen on lateral views;
- oblique views may be required to visualize the main frx line;
- ref: Capitellar fracture in a child: the value of an oblique radiograph. A case report
    - closed treatment:
            - if closed reduction is obtained, then reduction is usually stable w/ elbow flexion;
            - references:
Closed Reduction and Early Mobilization in Fractures of the Humeral Capitellum.
- Closed reduction of coronal fractures of the capitellum
- Capitellar Fractures - Is ORIF Necessary?
    - operative treatment: excision of fragment
-
Effect of coronal shear fractures of the distal humerus on elbow kinematics and stability
            - Fracture of the capitulum humeri. Treatment by excision.
    - percutaneous pin fixation:
            -  Capitulum Fracture: Result of Percutaneous Fixation and Review of Literature
    - operative treatment: ORIF
            - extended Kocher approach to the elbow;
- hardware may include Herbert bone screw or 4.0 mm cancellous screws (which are inserted from posterior to anterior)
- displaced frxs are treated with ORIF with one or two Herbert screws;
- references:
- Nonunion of Operatively Treated Capitellum and Trochlear Fractures
- Reconstruction of radial capitellar fractures using fine-threaded implants (FFS).
- Open reduction and internal fixation of capitellar fractures with headless screws
- Open reduction and internal fixation of capitellar fractures with headless screws. Surgical technique.
- Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws.
                  - Fractures of the Capitellum and Trochlea
                  - Minimal Invasive Technique in Capitellum Fracture Treatment
Hahn-Steinthal fracture: a case report

- Type II: (Kocher Lorez Frx);
- affects primarily anterior articular cartilage and very little underlying bone;
- these usually cause few subsequent joint problems;
- type II, or Kocher Lorenz fracture, is a sleeve fracture of articular surface with little osseous bone;
- healing potential is minimal & excision is recommended;
- references:
- Type II Fracture of the Capitellum. Operative Treatment of a Rare Injury
           - Effect of coronal shear fractures of the distal humerus on elbow kinematics and stability
- Arthroscopic excision of type II capitellar fractures
- The often-missed Kocher-Lorenz elbow fracture

- Type III: (Broberg and Morrey);
- comminuted frx of the capitellum;
    - operative treatment: excision of fragment
-
Effect of coronal shear fractures of the distal humerus on elbow kinematics and stability

- Type IV:
    - ref: Type 4 capitellum fractures: Diagnosis and treatment strategies


Capitellar Fractures in Children and Adolescents: Classification and Early Results of Treatment
Fractures of the capitellum.
Surgical treatment of fractures of the capitellum in adults: a modified technique.
Surgical management of fracture of the capitulum humeri.
Fracture of the capitulum humeri.
Internal fixation of a capitellar fracture using Herbet screws. A case report.
Coronal shear fractures of the distal end of the humerus.
Multiplane fracture of the distal humerus.
Combined shear fractures of the trochlea and capitellum associated with anterior fracture-dislocation of the elbow.
Closed Reduction and Early Mobilization in Fractures of the Humeral Capitellum.