Objective： Fractures of the capitellum and trochlea constitute less than 1% of all elbow fractures and a shear fracture involving the capitellum and extending medially into most of the trochlea is rarely reported. Ty...Objective： Fractures of the capitellum and trochlea constitute less than 1% of all elbow fractures and a shear fracture involving the capitellum and extending medially into most of the trochlea is rarely reported. Type Ⅳ capitellum fracture is still controversial in regard to its ra- diographic appearance, surgical approach and osteosynthesis. We report 10 cases of type Ⅳ capitellum fracture with a view to elucidating its clinical features and treatment outcome. Methods： We treated 10 patients of type Ⅳ capitellum fracture with a mean age of 32 years. A uniform surgical approach and postoperative rehabilitation were followed. Results： Nine patients presented to us after a mean of 4 days of injury and one patient was nonunion after 6 months of injury who had been treated conservatively by a bone setter. Double arc sign was absent in 6 cases. Intraopera- tively 6 capitellotrochlear fragments were devoid of soft tissue attachments. By Mayo Elbow Performance Score evaluation, 7 patients got excellent, 2 good and 1 fair results. One patient with associated elbow dislocation developed heterotopic ossification. There was no case of avascular necrosis, osteoarthrosis or fixation failures. Conclusions： Type Ⅳ capitellum fractures are rare and belong to complex articular injuries. A good functional out- come can only be achieved with open reduction and stable internal fixation followed by early mobilization. Preopera- tive radiographic assessment and computed tomography help surgeons in choosing the right surgical approach and implants. Good surgical technique and stable internal fixa- tion are the keys to early mobilization and good functional outcome.展开更多
文摘Objective： Fractures of the capitellum and trochlea constitute less than 1% of all elbow fractures and a shear fracture involving the capitellum and extending medially into most of the trochlea is rarely reported. Type Ⅳ capitellum fracture is still controversial in regard to its ra- diographic appearance, surgical approach and osteosynthesis. We report 10 cases of type Ⅳ capitellum fracture with a view to elucidating its clinical features and treatment outcome. Methods： We treated 10 patients of type Ⅳ capitellum fracture with a mean age of 32 years. A uniform surgical approach and postoperative rehabilitation were followed. Results： Nine patients presented to us after a mean of 4 days of injury and one patient was nonunion after 6 months of injury who had been treated conservatively by a bone setter. Double arc sign was absent in 6 cases. Intraopera- tively 6 capitellotrochlear fragments were devoid of soft tissue attachments. By Mayo Elbow Performance Score evaluation, 7 patients got excellent, 2 good and 1 fair results. One patient with associated elbow dislocation developed heterotopic ossification. There was no case of avascular necrosis, osteoarthrosis or fixation failures. Conclusions： Type Ⅳ capitellum fractures are rare and belong to complex articular injuries. A good functional out- come can only be achieved with open reduction and stable internal fixation followed by early mobilization. Preopera- tive radiographic assessment and computed tomography help surgeons in choosing the right surgical approach and implants. Good surgical technique and stable internal fixa- tion are the keys to early mobilization and good functional outcome.
