1
|
Lari A, Alrumaidhi Y, Martinez D, Ahmad A, Aljuwaied H, Alherz M, Prada C. Clinical Outcomes and Management Strategies for Capitellum and Trochlea Fractures: A Systematic Review. Orthop Res Rev 2024; 16:179-197. [PMID: 38947420 PMCID: PMC11214803 DOI: 10.2147/orr.s472482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/20/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Capitellum and trochlea fractures, also referred to as coronal shear fractures of the distal humerus, are infrequent yet challenging intra-articular fractures of the elbow. There are a variety of surgical approaches and fixation methods with often variable outcomes. This systematic review investigates interventions, outcomes and complications of capitellum and trochlea fractures. Methods A systematic review of studies published in MEDLINE, EMBASE, Web of Science and Cumulative Index to Nursing and Allied Health literature (CINAHL) was conducted to assess the clinical outcomes of capitellum and trochlea fractures managed surgically. Data on patient demographics, surgical approach, implant usage, postoperative outcomes and complications were compiled. Results Forty-one studies met the inclusion criteria with a total of 700 patients. Surgical interventions primarily utilized either the lateral (79%) or antero-lateral (15%) approaches with headless compression screws as the most common fixation method (68%). Clinical outcomes were measured using the Mayo Elbow Performance Index (MEPI) with a mean score of 89.9 (±2.6) and the DASH score with a mean of 16.9 (±7.3). Elbow range of motion showed a mean flexion of 126.3° (±19.4), extension of 5.71° (±11.8), pronation of 75.23° (±12.2), and supination of 76.6° (±9.8). The mean flexion-extension arc was 113.7° (±16.9), and the mean pronation-supination arc was 165.31° (±9.41). Complications occurred in 19.8% of cases, with re-interventions required in 8.3% of cases, mainly due to symptomatic implants and elbow stiffness requiring surgical release. Other complications included implant removal (10.4%), overall reported stiff elbows (6%), nerve palsies (2%), non-union (1.5%), and infection (1.2%). Conclusion The treatment of capitellum and trochlea fractures yields satisfactory outcomes but has a considerable rate of complications and reoperations primarily due to symptomatic implants and elbow stiffness. There is noteworthy variability in the achieved range of motion, suggesting unpredictable outcomes. Deficits in functionality and range of motion are common after surgery, especially with more complex injury patterns.
Collapse
Affiliation(s)
- Ali Lari
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Yasmen Alrumaidhi
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Diego Martinez
- Hospital of the Worker of Santiago: Hospital del Trabajador de Santiago, Santiago, Chile
| | - Amaar Ahmad
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Hamad Aljuwaied
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Mohammad Alherz
- Department of Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Carlos Prada
- St Joseph’s Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
2
|
Heller M, Abdelaal MS, Adams A, Ilyas AM, Kachooei AR. Rate of Complications After Capitellum Fracture Fixation: A Systematic Review and Meta-Analysis. J Hand Surg Am 2023:S0363-5023(23)00590-7. [PMID: 38032550 DOI: 10.1016/j.jhsa.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 10/17/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE This systematic review aimed to determine the incidence of complications following surgical fixation of an acute capitellum fracture. We secondarily aimed to compare the complication rate between anterior-to-posterior (A-P) versus posterior-to-anterior (P-A) screw insertion. METHODS PubMed, EMBASE, and Scopus were searched to identify studies on surgical fixation of capitellum fractures in skeletally mature patients. The main outcome was the rate of complication after fracture fixation. Subgroup analysis was performed to assess the impact of the fixation technique on the outcomes after surgery. An inverse variance method using random or fixed effects models was used to perform a meta-analysis based on the degree of heterogeneity between studies. Study heterogeneity was evaluated using Q statistics to calculate the I2 index. RESULTS We included 42 studies in the final analysis. The most reported complications after surgical fixation of capitellum fractures included elbow pain (21%), radiocapitellar arthritis (19%), hardware removal (17%), and heterotopic ossification (13%). When groups were stratified based on the direction of screw insertion, the mean rate of avascular necrosis was higher in the P-A direction (29% vs 11%). In comparison, the rate of revision fixation (2.9% vs 6.7%) and heterotopic ossification (7.3% vs 22%) were higher in the A-P direction. Transient posterior interosseous nerve palsy was reported in four patients in four studies, of whom three patients had A-P screw fixation. CONCLUSION Fixation of a displaced capitellum fracture is recommended when possible. However, patients should be counseled about the potential risk of complications and chances of undergoing an unplanned surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Mike Heller
- Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Alexander Adams
- Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, PA, USA
| | - Asif M Ilyas
- Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Amir R Kachooei
- Rothman Orthopaedics Florida at AdventHealth, Orlando, Florida, USA; Department of Orthopaedic Surgery, University of Central Florida, Orlando, Florida, USA.
| |
Collapse
|
3
|
Hackl M, Lanzerath F, Ries C, Harbrecht A, Leschinger T, Wegmann K, Müller LP. Trans-fracture approach for ORIF of coronal shear fractures of the distal humerus. Arch Orthop Trauma Surg 2022; 143:2519-2527. [PMID: 35731264 PMCID: PMC10110670 DOI: 10.1007/s00402-022-04501-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Open reduction and internal fixation (ORIF) of comminuted coronal shear fractures of the distal humerus is challenging. When a concomitant lateral condyle fracture is present, it may be used for a trans-fracture approach to facilitate exposure and fracture reduction. This study aimed to investigate the frequency of lateral condyle fractures in coronal shear fractures of the distal humerus and analyze fracture reduction, fracture union and clinical results following ORIF through a trans-fracture approach. MATERIALS AND METHODS All adult patients who underwent treatment for an acute distal humerus fracture during a three-year period in our level-one trauma center were identified. All fractures were classified according to the Orthopaedic Trauma Association (OTA/AO) fracture classification system and all B3 fractures were classified according to the Dubberley classification. B3 fractures with a concomitant radial condyle fracture were identified. The clinical and radiological results, (Mayo Elbow Performance Score = MEPS, Visual Analogue Scale = VAS, range of motion), complications and revision surgeries were analyzed. RESULTS 53 patients (mean age 52 ± 19 years) were identified. 13 fractures (24.5%) were B3 fractures. Four of them (30.8%) had a concomitant radial condyle fracture. All of these patients underwent ORIF with headless cannulated compression screws and a (postero-)lateral locking plate through a trans-fracture approach. At a minimum follow-up of 24 months, the MEPS was 88 ± 12 points, the VAS was 2 ± 1 and the range of motion was 118° ± 12°. All fractures showed anatomic reduction. One patient developed partial avascular necrosis and underwent arthrolysis at 6 months. One patient underwent partial hardware removal and lateral collateral ligament bracing at 6 months. CONCLUSIONS Lateral condyle fractures are present in about one third of coronal shear fractures of the distal humerus. This injury can be used for a trans-fracture approach to facilitate exposure and to reliably achieve anatomic fracture reduction.
Collapse
Affiliation(s)
- Michael Hackl
- Faculty of Medicine, University of Cologne, Cologne, Germany. .,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany.
| | - Fabian Lanzerath
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Christian Ries
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Harbrecht
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Tim Leschinger
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Kilian Wegmann
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Lars Peter Müller
- Faculty of Medicine, University of Cologne, Cologne, Germany.,Center of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
4
|
Song Z, Wang Q, Ma T, Wang C, Yang N, Xue H, Li Z, Zhu Y, Zhang K. Anti-sliding plate technique for coronal shear fractures of the distal humerus. J Orthop Surg Res 2020; 15:18. [PMID: 31952529 PMCID: PMC6969457 DOI: 10.1186/s13018-019-1466-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/08/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The purpose of this study is to discuss the surgical strategy, technical feasibility, and clinical efficacy of coronal shear fractures of the distal humerus using the anti-sliding plate technique. METHODS Fifty-two patients (35 males and 17 females) were treated with the anti-sliding plate technique in our hospital from January 2012 to January 2017. The average age of the patients was 40.4 years. They were classified according to the Dubberley classification system and treated with the anti-sliding plate technique. The long-term functional scores represented by the Mayo Elbow Performance Index and complications were evaluated. RESULTS Fractures were classified as follows: 11 type-IA, 5 type-IB, 16 type-IIA, 4 type-IIB, 13 type-IIIA, and 3 type-IIIB according to the Dubberley classification system. All patients were treated with open reduction and internal fixation by the extensile lateral approach and completed a clinical and radiographic follow-up (average, 17.6 months). The average Mayo elbow performance score was 90.6 points, with 36 excellent, 11 good, and 5 fair results. The average range of movement of the elbow joint was 3° (0-15°) for extension and 136° (90-150°) for flexion. CONCLUSIONS The anti-sliding plate technique follows basic AO principles and neutralizes the shearing force combined with lag screws and/or Kirschner wires after the anatomic reduction of the fracture. It allows for the stable internal fixation of the fracture, which is critical for early mobilization and a good functional outcome. LEVEL OF EVIDENCE Level IV, Case Series, Treatment Study.
Collapse
Affiliation(s)
- Zhe Song
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Qian Wang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Teng Ma
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Chen Wang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Na Yang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Hanzhong Xue
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Zhong Li
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Yangjun Zhu
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China.
| |
Collapse
|
5
|
Soubeyrand M, Assabah B, Bégin M, Laemmel E, Dos Santos A, Crézé M. Pronation and supination of the hand: Anatomy and biomechanics. HAND SURGERY & REHABILITATION 2017; 36:2-11. [DOI: 10.1016/j.hansur.2016.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 11/15/2022]
|