Therapeutic subclassification of type IV capitellum fracture: a new approach

Autor: Nagesh Naik, Shreyansh J. Parakh, Shrikant B Deshpande
Rok vydání: 2015
Předmět:
Zdroj: European Orthopaedics and Traumatology. 6:373-379
ISSN: 1867-4577
1867-4569
Popis: This fracture is rare and is often missed in emergency if good lateral radiographs are not available. This paper presents the diagnosis and management of type 4 capitellar fractures (Mckee) with 4-mm cancellous screws after subclassification of fracture and different surgical modalities for each subtype Five cases were treated from 2012 to 2014 for type IV capitellar fracture of the right side. There were three males and two females, all adult with an average age of 31 years. Double arc sign was seen in lateral view in three patients. No patient underwent CT scan. Under tourniquet, using extended lateral approach, open reduction and internal fixation was done using 4-mm partially threaded cannulated cancellous screws under vision from posterior to anterior direction from the posterior aspect of lateral condyle of the humerus avoiding articular penetration (except one screw). If the fracture was found to involve medial flange of the trochlea, then one cancellous screw was passed through posteromedial incision (type B). All the fractures united uneventfully. At the end of 1 year follow-up, all had excellent elbow function with no signs of AVN or arthritis. Double arc sign on lateral X-rays of the elbow is important for diagnosis and analysis of type IV capitellar fracture. Fixation with cannulated ordinary screws using extended Kocher’s lateral approach has given good results. Subclassification with medial screw for type B helped to anatomically reduce and stabilize type B fracture. Thus, the subclassification has a therapeutic value.
Databáze: OpenAIRE
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