Background: Capitellar and trochlear fractures are uncommon
fractures of the distal aspect of the humerus. There is limited information
about the functional outcome of patients managed with open reduction and
internal fixation.
Methods: The functional outcome of twenty-eight patients, with a
mean age (and standard deviation) of 43 ± 13 years, who were treated
with open reduction and internal fixation for capitellar and trochlear
fractures was evaluated at a mean duration of follow-up of 56 ± 33
months. Patient outcomes were assessed with physical and radiographic
examination, range-of-motion measurements, strength testing, and self-reported
questionnaires (Short Form-36, Mayo Elbow Performance Index, American Shoulder
and Elbow Surgeons Elbow Assessment Form, and Patient-Rated Elbow Evaluation
scales).
Results: Eleven fractures involved the capitellum with or without
fracture of the lateral ridge of the trochlea, four involved the capitellum
and trochlea as one piece, and thirteen involved the capitellum and trochlea
as separate fragments. These fractures were further characterized by the
presence or absence of posterior comminution. Fourteen patients had isolated
fractures, and fourteen had other elbow, forearm, or wrist injuries. Patients
with more complex fractures required more extensive surgery, had more
complications resulting in secondary procedures, and had poorer outcomes
compared with those with simple fractures. The average score on the Mayo Elbow
Performance Index (91 ± 11), the average quality-of-life scores (46 on
the physical component and 50 on the mental component of the Short Form-36),
and the average range of motion (19° to 138°) suggest favorable
patient outcomes overall. Two comminuted fractures did not unite and required
conversion to a total elbow arthroplasty.
Conclusions: Patients with isolated noncomminuted capitellar and/or
trochlear fractures have better results than those with more complex
fractures. A classification system based on the radiographic patterns of these
fractures is recommended.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.