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Capitelar and Coronal Shear Frx


- 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.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Saturday, September 2, 2017 6:07 am