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Surgical tips and tricks for coronal shear fractures of the elbow

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Coronal shear fractures of the distal humerus represent an uncommon lesion and could be burdened by high complications. This complex lesion requires an accurate reduction and surgical fixation for a better outcome. Different techniques have been described, however no standard protocol have been proposed.

Purpose of this retrospective study, is to evaluate the clinical and radiological outcome with posterior cannulated self-tapping headless screws followed by an early-active-motion protocol and to outline the surgical tips and tricks for different fracture patterns.

Materials and methods

From 2013 to 2019, a consecutive series of 24 patients with coronal shear fracture undergoing ORIF were included in the study. Fractures were classified according to Dubberley’s classification. Cannulated self-tapping headless screws were used to fix the fragments.

When necessary, additional cannulated half-threaded screws on the lateral edge of the humerus were used, as well as bone chips and fibrin sealant on severe comminution. All patients underwent an assisted early-active-motion rehabilitation protocol. Mean follow-up was 30 months; patients underwent standard X-rays and clinical outcome assessment with range of motion, Broberg and Morrey score and MEPI score.

Results

Surgical fixation with headless screw guaranteed complete healing of all shear fractures examined, no loss of reduction were reported. ROM assessment showed good results with an average arc of 113.1°. Excellent to good Broberg-Morrey and MEPI score were reported.

No cases of avascular necrosis nor post-traumatic osteoarthritis resulted in our series.

Complications occurred in 16.6% of the patients.

Conclusion

Coronal shear fracture represents a challenging injury to treat. Anatomical reduction and the use of cannulated self-tapping headless screws from posterior provide a stable fixation, high union rates and good elbow function, with a low cartilage damage and risks of necrosis over 2 years of follow-up.

Level of evidence

Therapeutic III

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Orthopaedic and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy

    Luigi Tarallo, Michele Novi, Giuseppe Porcellini, Andrea Giorgini, Gianmario Micheloni & Fabio Catani

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  1. Luigi Tarallo
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  2. Michele Novi
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  3. Giuseppe Porcellini
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  4. Andrea Giorgini
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  5. Gianmario Micheloni
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  6. Fabio Catani
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Contributions

LT designed the study. MN and AG collected data. GP and FC contributed to interpretation of data. MN, LT and GM drafted the manuscript. All authors critically revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Luigi Tarallo.

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The authors declare that they have no competing interests.

Ethical approval

All patients gave informed consent prior to being included in this retrospective study performed in accordance with the Ethical Standards of the 1964 Declaration of Helsinki as revised in 2000.

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Written informed consent was obtained from each patient for publication.

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Tarallo, L., Novi, M., Porcellini, G. et al. Surgical tips and tricks for coronal shear fractures of the elbow. Arch Orthop Trauma Surg 141, 261–270 (2021). https://doi.org/10.1007/s00402-020-03500-9

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  • DOI: https://doi.org/10.1007/s00402-020-03500-9

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