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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.