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Therapeutic subclassification of type IV capitellum fracture: a new approach

  • Original Article
  • Published:
European Orthopaedics and Traumatology

Abstract

Background

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

Material and methods

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).

Results

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.

Conclusion

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.

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Acknowledgments

The authors thank Dr Sunil V. Patil, Professor and HOD, Department of Orthopaedics, Bharati Vidyapeeth Deemed University and Medical College, Sangli, for his inspiring support and guidance.

Compliance with Ethical Standards

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. A written, valid and informed consent has been taken from all the human subjects involved in the study. This article does not contain any studies with animals performed by any of the authors.

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Authors and Affiliations

  1. Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, India

    Nagesh P. Naik, Shreyansh J. Parakh & Shrikant B. Deshpande

  2. Memorial Accident and Orthopaedic Hospital, Ambedkar Road, Near S.T.Stand, Sangli, Maharashtra, India, 416416

    Nagesh P. Naik

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  1. Nagesh P. Naik
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  2. Shreyansh J. Parakh
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Correspondence to Nagesh P. Naik.

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Naik, N.P., Parakh, S.J. & Deshpande, S.B. Therapeutic subclassification of type IV capitellum fracture: a new approach. Eur Orthop Traumatol 6, 373–379 (2015). https://doi.org/10.1007/s12570-015-0319-x

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  • DOI: https://doi.org/10.1007/s12570-015-0319-x

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