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Zhang C, Chen FX, Ma K, Ma JT. Surgical treatment of coronal shear fractures of the distal humerus with an intact lateral epicondyle by the lateral combined approach. J Shoulder Elbow Surg 2024; 33:1685-1693. [PMID: 38609005 DOI: 10.1016/j.jse.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Coronal shear fractures of the distal humerus are not only rare and prone to misdiagnosis, but their surgical treatment can be challenging. We aimed to investigate the feasibility of exposing distal humeral coronal shear fractures with a combined lateral approach that preserves the extensors and lateral ulnar collateral ligament (LUCL) and to analyze the clinical efficacy of open reduction and internal fixation in the treatment of these injuries. METHODS We included 45 patients who sustained coronal shear fractures of the distal humerus with the lateral epicondyle intact and were treated with open reduction and internal fixation from January 2013 to August 2020. The fractures were exposed by the lateral combined approach in which the tendons involving the common extensor, the extensor carpi ulnaris, and the LUCL were preserved. Two observation windows were formed anterior to and posterior to these tendons and the LUCL was used to achieve fracture reduction. Countersunk screws, with or without a plate placed on the posterior lateral condyle, were used to fix the fragments. The functional outcomes of these patients were reviewed and assessed with physical and radiographic examinations, range of motion measurements, and self-evaluation Mayo Elbow Performance Index and the Disabilities of the Arm, Shoulder, and Hand scores. RESULTS In total, 40 patients were followed up with for over 1 year and were included in the final analysis. The mean follow-up duration was 42 ± 30 months (range, 12-107 months). The patients' mean age was 42 years (range, 14-74 years). According to the Dubberley Classification, there were 15 type I, 17 type II, and 8 type III fractures. At the final follow-up, the mean flexion-extension arc was 131° (range, 65-150) and mean pronation and supination was 73° (range, 45-80) and 71° (range, 40-80), respectively. The mean Mayo Elbow Performance Index score was 88 (range, 61-97) points; the results were excellent in 21, good in 13, fair in 4, and poor in 2 patients. The mean Disabilities of the Arm, Shoulder, and Hand score was 11 (range, 0-42) points. Neither functional score nor range of movement was associated with age, sex, fracture type, injury type, or surgical timing. CONCLUSION Reduction and stable fixation with internal fixation for coronal shear fractures of the distal humerus can be achieved by the lateral combined approach. Early functional mobilization allows for satisfactory restoration of elbow function.
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Affiliation(s)
- Chuan Zhang
- Shoulder and Elbow Surgery Center, Luoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan Province, Zhengzhou, China.
| | - Fei Xiong Chen
- Shoulder and Elbow Surgery Center, Luoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Kun Ma
- Shoulder and Elbow Surgery Center, Luoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Jiang Tao Ma
- Shoulder and Elbow Surgery Center, Luoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan Province, Zhengzhou, China
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Patel UJ, Dondapati A, Carroll T, Soin S. Technical trick: buttress plate fixation of comminuted capitellum fractures with combined suture repair of the lateral ulnar collateral ligament. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:576-582. [PMID: 37929000 PMCID: PMC10624994 DOI: 10.1016/j.xrrt.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Urvi J. Patel
- University of Rochester Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Akhil Dondapati
- University of Rochester Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas Carroll
- University of Rochester Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Sandeep Soin
- University of Rochester Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
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Wallace DR, Shiver AL, Pulliam SK, Byrd BM, McGee-Lawrence ME, Snoddy MC. Intramedullary Threaded Nail Fixation Versus Plate and Screw Construct in Metacarpal Neck Fractures: A Biomechanical Study. J Am Acad Orthop Surg 2023; 31:e516-e522. [PMID: 37071886 PMCID: PMC10198952 DOI: 10.5435/jaaos-d-22-00595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/16/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Indicated surgical management of metacarpal neck fractures varies with techniques, including Kirschner wire fixation, plate fixation, intramedullary fixation, and headless compression screw fixation, without demonstrated superiority. This study compares intramedullary threaded nail (ITN) fixation with a locking plate construct. METHODS Index through small finger metacarpals were harvested from 10 embalmed cadavers. After application of appropriate exclusion criteria, remaining metacarpals underwent neck fracture creation by a three-point load to failure. Eight samples were randomly allocated to fixation with ITN fixation, and six were stabilized with a 2.3-mm seven-hole locking plate. Samples were then subjected to a second round of biomechanical testing using the same apparatus. Ultimate load between the intact tissue and the subsequently stabilized fracture was analyzed with a paired Student t -test. Percentage change in ultimate load in the intact tissue and stabilized tissue was calculated, and the magnitude of relative difference between the two groups was analyzed using unpaired Student t -tests. Statistical difference was defined by a P value of < 0.05. RESULTS Both groups demonstrated the ability to handle a biomechanical load; however, both were significantly weaker than the intact tissue (paired Student t -test p ITN-fixed versus p ITN-intact = 0.006; p plate-fixed versus p plate-intact = 0.002). ITN samples demonstrated a higher load to failure (unpaired Student t -test p ITN-fixed versus p plate-fixed = 0.039). CONCLUSION ITN provides a biomechanically stronger fixation constructed for vertically oriented metacarpal neck fractures compared with locking plate fixation. Both ITN and locking plate constructs provide stabilization capable of tolerating a biomechanical load; however, both fixation modalities are weaker than the native tissue.
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Affiliation(s)
- Doyle R Wallace
- From Medical College of Georgia at Augusta University, Augusta, GA
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Ishizaka K, Moriya K, Yamamoto K, Matsuyama Y, Koda H, Tsubokawa N. Distal humeral osteotomy combined with posterior olecranon osteotomy approach for coronal shear fracture of the distal humerus: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:256-259. [PMID: 37588445 PMCID: PMC10426633 DOI: 10.1016/j.xrrt.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Koji Moriya
- Niigata Hand Surgery Foundation, Niigata, Japan
| | | | | | - Hisao Koda
- Niigata Hand Surgery Foundation, Niigata, Japan
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Long-Term Outcomes and Return to Work After Isolated Coronal Shear Fractures of the Capitellum. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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6
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Zhang Y, Chang N, Athwal GS, King GJW. Arthroscopic reduction and internal fixation of capitellar and trochlear fractures: A case series. Shoulder Elbow 2023; 15:75-81. [PMID: 36895598 PMCID: PMC9990109 DOI: 10.1177/17585732211037617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/15/2022]
Abstract
Background In a simple isolated capitellar/trochlear fracture without extensive posterior comminution, arthroscopic reduction and internal fixation (ARIF) can provide an alternative option to open reduction internal fixation. The purpose of this retrospective case series was to report on the technique and outcomes of arthroscopic reduction and internal fixation of capitellar/trochlear fractures. Methods All patients that underwent ARIF at a single upper extremity referral centre in the last twenty years were reviewed. Patient demographics, preoperative, intraoperative, and postoperative records were obtained through chart review and telephone followup. Results Ten cases of ARIF were identified over a twenty year period performed by two surgeons. The average age of patients was 37 years (17-63 years), with nine females and one male. With an average followup of eight years, nine of ten patients had a mean range of motion from 0 to 142 degrees. Their average MEPI and PREE score were 93 ± 7 and 8 ± 14, respectively. Four patients had focal cartilage collapse with three that required a reoperation. There were no infections, nonunions, or arthroscopy related complications. Conclusion ARIF offers an alternative to ORIF for capitellar/trochlear fractures producing good results while providing better visualization of the fracture reduction and minimizing soft tissue dissection.
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Affiliation(s)
- Yiyang Zhang
- Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health
Care, Division of Orthopaedic Surgery, University of Western
Ontario, London, ON, Canada
| | - Nicholas Chang
- Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health
Care, Division of Orthopaedic Surgery, University of Western
Ontario, London, ON, Canada
| | - George S Athwal
- Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health
Care, Division of Orthopaedic Surgery, University of Western
Ontario, London, ON, Canada
| | - Graham JW King
- Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health
Care, Division of Orthopaedic Surgery, University of Western
Ontario, London, ON, Canada
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Vicenti G, Bizzoca D, Zaccari D, Buono C, Carlet A, Solarino G, Giorgino R, Santolini E, Lunini E, Zavattini G, Ottaviani G, Carrozzo M, Simone F, Marinelli A, Rotini R, Franchini A, Moretti B. Choice of treatments of the coronal shear fractures of the humerus. A national survey of Italian AO members. Injury 2022; 54 Suppl 1:S78-S84. [PMID: 36400627 DOI: 10.1016/j.injury.2022.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Coronal shear fractures of the distal humerus are uncommon injuries representing 6% of distal humeral fractures. There is no univocal consensus about the correct management of this type of fracture. A national survey was conducted to gain more insight into the current classification, diagnosis and treatment of coronal shear fractures in Italy. MATERIALS AND METHODS A postal survey was sent to all AO Italian members including residency orthopaedic surgeons. The survey consisted of general questions about personal experience in the management of these fractures: types of classification systems used, surgical approaches, treatment options and rehabilitation programs. RESULTS 114 orthopaedic surgeons answered a 13-items questionnaire. The most used classification system was AO/OTA (72,8%). Independent screws and if necessary plates were the most answered regarding surgical treatment (81,6%). The most encountered post-surgical complication was stiffening of the elbow (81,6%). CONCLUSION An algorithm of treatment has been proposed. To better classify coronal shear fractures, the authors recommended the integration of two classification systems: AO and Dubberley classifications. In the case of posterior wall comminution, a Kocher extensile approach is recommended, otherwise, if a posterior wall is intact, Kocher or Kaplan approach can be used. The posterior transolecranic approach can be reserved to Dubberley type III or AO 13B3.3. The best treatment choice is represented by independent screws and plates placed according to fracture patterns while arthroplasty is indicated when a stable ORIF is not possible. Mobilization is postponed for about 2 weeks.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Domenico Zaccari
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Claudio Buono
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Arianna Carlet
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Emmanuele Santolini
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Enricomaria Lunini
- Orthopedics and Trauma Unit, ASST Lariana Ospedale Sant'Anna, Como, Italy
| | - Giacomo Zavattini
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Guglielmo Ottaviani
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Filippo Simone
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | | | - Roberto Rotini
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Franchini
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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Lung B, MacGillis K, Iyer H, Karasavvidis T, Wang E. Anatomic study of an anterior portal for percutaneous internal fixation of capitellum fractures. J Shoulder Elbow Surg 2022; 31:2043-2048. [PMID: 35472575 DOI: 10.1016/j.jse.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/05/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fractures of the capitellum are uncommon and difficult to treat surgically. Capitellar open reduction-internal fixation uses a lateral open approach with posterior-to-anterior or anterior-to-posterior screw fixation. We investigated the use of an anterior portal for placement of anterior-to-posterior screw fixation through cadaveric measurement of the anatomic relationships from an anteriorly to posteriorly placed Kirschner wire (K-wire) to anterior elbow structures and calculated the percentage of articular surface accessed from the anterior portal. METHODS Eight fresh-frozen cadaveric elbows without radiographic or cutaneous evidence of prior trauma or surgery were used for this study. An arthroscopic proximal anteromedial portal was cannulized, and the radiocapitellar joint was evaluated. A single 1-cm portal was placed 1 cm distal to the elbow flexion crease and based lateral to the biceps tendon. The location of the portal was confirmed with a spinal needle, and blunt dissection with a hemostat was performed down to capsular tissue and for arthrotomy. A spinal needle sheath was threaded over a blunt switching stick and served as a cannula for placement of a 0.062 K-wire. Articular mapping was performed with cartilage scraping by the K-wire; the K-wire was then placed at the perceived center along the proximal-to-distal and radial-to-ulnar axis of the capitellum. Fluoroscopic confirmation of the wire's location was performed. Under loupe magnification, anatomic dissection was performed and the shortest distance measurements were recorded with digital calipers from the K-wire to the dissected structures. Capitellar articular measurements were recorded, in addition to the articular area defined by the K-wire. Data analysis was performed, and the average distance and standard deviation (in millimeters) were calculated. For structures that were pierced by or touching the K-wire, the distance was recorded as 0.1 mm. RESULTS The average distance from the K-wire to the radial, lateral antebrachial cutaneous, and median nerves was 1.8 mm, 11.5 mm, and 28.0 mm, respectively. The average distance from the median cubital vein and biceps tendon was 3.7 mm and 13.4 mm, respectively. The pin track pierced the brachioradialis and supinator muscles in all but 1 specimen. The average capitellar articular surface marked was 39.1% of the calculated articular footprint of the capitellum. CONCLUSIONS The anterior portal to the capitellum is directly adjacent to the radial nerve and lateral antebrachial cutaneous nerve, where each is susceptible to injury. We recommend blunt dissection and insertion of a cannula to allow drilling and placement of internal fixation in a relatively safe manner with respect to neurovascular structures.
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Affiliation(s)
- Brandon Lung
- Department of Orthopaedic Surgery, University of California Irvine Health, Orange, CA, USA.
| | - Kyle MacGillis
- Department of Orthopaedics, Stony Brook University College of Medicine, Stony Brook, NY, USA
| | - Hari Iyer
- Department of Orthopaedics, Stony Brook University College of Medicine, Stony Brook, NY, USA
| | - Theofilos Karasavvidis
- Department of Orthopaedic Surgery, University of California Irvine Health, Orange, CA, USA
| | - Edward Wang
- Department of Orthopaedics, Stony Brook University College of Medicine, Stony Brook, NY, USA
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Fisher KJ, Livesey MG, Sax OC, Gilotra MN, O'Hara NN, Henn RF, Hasan SA. Are Outcomes After Fixation of Distal Humerus Coronal Shear Fractures Affected by Surgical Approach? A Systematic Review and Meta-analysis. JSES Int 2022; 6:1054-1061. [DOI: 10.1016/j.jseint.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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10
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Teraura H, Gotani H, Sakanaka H. Modified Posterior Trans-olecranon Approach in Tri-vision for Dubberley Type 3B Coronal Shear Fractures of the Distal Humerus. Cureus 2022; 14:e25175. [PMID: 35607317 PMCID: PMC9123390 DOI: 10.7759/cureus.25175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/05/2022] Open
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Humeral Capitellum Fractures in Adolescents: A Study of 6 Cases Treated by Open Reduction and Internal Fixation with Bioabsorbable Nails. Adv Orthop 2022; 2022:4012125. [PMID: 35449895 PMCID: PMC9017531 DOI: 10.1155/2022/4012125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose of our study was to evaluate the clinical outcome following open reduction and internal fixation of humeral capitellum fractures in adolescents and to assess the usefulness of bioresorbable implants in that procedure. Due to the rarity of these fractures, there are not many studies dealing with the problem in the literature. Methods We retrospectively evaluated a group of 6 skeletally immature patients aged 10.6–15.3 treated at our department from January 2015 to December 2021. Four type I and two type IV were diagnosed based on the Bryan and Morrey classification. Our patients underwent an open reduction and internal fixation of coronal shear fractures with the use of SmartNail®. Results All patients were satisfied with the treatment outcome and had full pronation and flexion after surgery. Two patients presented minor deficits of extension and supination compared with the contralateral elbow. At the one-year follow-up, all patients scored 100 on the Mayo Elbow Performance Score. Conclusions Correct diagnosis and early surgical intervention in humeral capitellum fractures are crucial. That fractures should be anatomically reduced with no articular cartilage damage in order to prevent osteoarthritis. Based on our experience, SmartNail® implant is accurate for the osteochondral fragment fixation.
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Nolte PC, Midtgaard K, Miles JW, Tanghe KK, Provencher MT. The Effect of Buttress Plating on Biomechanical Stability of Coronal Shear Fractures of the Capitellum: A Cadaveric Study. J Hand Surg Am 2022:S0363-5023(21)00801-7. [PMID: 35153076 DOI: 10.1016/j.jhsa.2021.12.007] [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: 03/03/2021] [Revised: 10/21/2021] [Accepted: 12/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare, using a cadaveric model, the biomechanical properties of headless compression screws (HCSs) and HCSs augmented with a buttress plate (BP) in capitellar fractures. METHODS Twenty pairs of fresh-frozen humeri (mean age, 46.3 years; range, 33-58 years) were used. The soft tissue was removed, and a Dubberley type IA capitellar fracture was created. One specimen in each pair was randomly assigned to receive either two 2.5-mm HCSs (HCS group) or two 2.5-mm HCSs augmented with an anterior 2.4-mm BP (HCS + BP group). This resulted in a similar distribution of the left and right humeri between the groups. Cyclic loading was performed, and displacement of the capitellum at 50, 100, 250, 500, 1,000, and 2,000 cycles was assessed using a motion capture system. This was followed by load-to-failure testing, wherein the load at a displacement of 1 and 2 mm was recorded. Failure was defined as 2-mm displacement. RESULTS During cyclic loading, there were no significant differences in the displacement between the HCS and HCS + BP groups at any of the assessed cycles. During load-to-failure testing, no significant strength differences were observed in the load at 1-mm displacement between the HCS (mean: 449.8 N, 95% CI: 283.6-616.0) and HCS + BP groups (mean: 606.2 N, 95% CI: 476.4-736.0). However, a significantly smaller load resulted in a 2-mm displacement of the fragment in the HCS group (mean: 668.8 N, 95% CI: 414.3-923.2) compared with the HCS + BP group (mean: 977.5 N, 95% CI: 794.1-1,161.0). CONCLUSIONS Anterior, low-profile buttress plating in addition to HCSs results in a significantly higher load to failure compared with HCSs alone in a biomechanical Dubberley type IA capitellar fracture model. CLINICAL RELEVANCE The addition of an anterior BP may be considered to improve initial stability in select cases such as osteoporotic patients or when the posterolateral column is frail.
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Affiliation(s)
- Philip C Nolte
- Steadman Philippon Research Institute, Vail, Colorado; BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen, Germany
| | - Kaare Midtgaard
- Steadman Philippon Research Institute, Vail, Colorado; Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Norwegian Armed Forces Joint Medical Services, Forsvarsvegen, Norway
| | - Jon W Miles
- Steadman Philippon Research Institute, Vail, Colorado
| | - Kira K Tanghe
- Steadman Philippon Research Institute, Vail, Colorado
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado; Steadman Clinic, Vail, Colorado.
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Akhtar M, Keshkar S, Barman R. Functional outcome of delayed surgical fixation of capitellar fractures treated by open reduction and internal fixation with herbert screw. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2022. [DOI: 10.4103/jotr.jotr_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Borbas P, Loucas R, Loucas M, Vetter M, Hofstede S, Ernstbrunner L, Wieser K. Biomechanical stability of complex coronal plane fracture fixation of the capitellum. Arch Orthop Trauma Surg 2022; 142:3239-3246. [PMID: 34424387 PMCID: PMC9522805 DOI: 10.1007/s00402-021-04126-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Coronal plane fractures of the distal humerus are relatively rare and can be challenging to treat due to their complexity and intra-articular nature. There is no gold standard for surgical management of these complex fractures. The purpose of this study was to compare the biomechanical stability and strength of two different internal fixation techniques for complex coronal plane fractures of the capitellum with posterior comminution. MATERIALS AND METHODS Fourteen fresh frozen, age- and gender-matched cadaveric elbows were 3D-navigated osteotomized simulating a Dubberley type IIB fracture. Specimens were randomized into one of two treatment groups and stabilized with an anterior antiglide plate with additional anteroposterior cannulated headless compression screws (group antiGP + HCS) or a posterolateral distal humerus locking plate with lateral extension (group PLP). Cyclic testing was performed with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure. RESULTS There was no significant difference in displacement during 2000 cycles (p = 0.291), stiffness (310 vs. 347 N/mm; p = 0.612) or ultimate load to failure (649 ± 351 vs. 887 ± 187 N; p = 0.140) between the two groups. CONCLUSIONS Posterolateral distal humerus locking plate achieves equal biomechanical fixation strength as an anterior antiglide plate with additional anteroposterior cannulated headless compression screws for fracture fixation of complex coronal plane fractures of the capitellum. These results support the use of a posterolateral distal humerus locking plate considering the clinical advantages of less invasive surgery and extraarticular metalware. LEVEL OF EVIDENCE Biomechanical study.
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Affiliation(s)
- Paul Borbas
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Rafael Loucas
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Marios Loucas
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Maximilian Vetter
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Simon Hofstede
- grid.5801.c0000 0001 2156 2780Institute of Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Karl Wieser
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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Calderazzi F, Schiavi P, Pogliacomi F, Tacci F, Vaienti E, Ceccarelli F. Involvement of the medial and lateral epicondyles in distal humeral coronal shear fractures: Case series and literature review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1341-1356. [PMID: 34514547 DOI: 10.1007/s00590-021-03113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/02/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Epicondyle involvement in capitellar and trochlear fractures is often considered a simple associated lesion that does not substantially change treatment or prognosis. Although theoretically predicted in reviews, case series almost never report elbow prosthesis use in comminuted coronal shear injuries associated with epicondylar fracture in the elderly. The purpose of this study is to focus on this underestimated injury pattern that can be a negative risk factor for treatment and prognosis. METHODS We retrospectively reviewed all cases with coronal shear fracture of the distal humerus treated from 2016 to 2019. Fractures were classified according to Dubberley. Open reduction and internal fixation (ORIF) were performed when possible. Partial or total elbow replacement was used in severely comminuted fractures with epicondylar involvement in four elderly patients. RESULTS Nineteen consecutive patients were selected (mean age: 62.4 years), of which 10 had type 3A/3B fractures, and seven had both medial and lateral epicondylar involvement. The mean follow-up duration was 31.78 months. The average Mayo Elbow Performance Index (MEPI) score was 81.05 points, with 7 excellent, 8 good, 1 fair, and 3 poor results. The average MEPI score of Dubberley's type 1 and type 2 was better than that of type 3 (mean: 92 vs. 72, p = 0.02). Further, the results of average range of motion were better in patients who had sustained Dubberley types 1 and 2 lesions than those with Dubberley type 3 lesion (mean: 133° vs. 85°, p = 0.002). Two patients out of three who required intra-operative conversion to total elbow arthroplasty had poor outcomes. CONCLUSIONS The simultaneous presence of fracture of one or both epicondyles are usually associated with severe joint comminutions and makes ORIF more challenging, especially among elderly women. In these cases, primary total elbow prosthesis implantation could be a valid treatment option.
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Affiliation(s)
- Filippo Calderazzi
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy.
| | - Paolo Schiavi
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy
| | - Francesco Pogliacomi
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy
| | - Fabrizio Tacci
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy
| | - Enrico Vaienti
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy
| | - Francesco Ceccarelli
- Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100, Parma, Italy
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Gomez V, Cairns M, Weinhold P, Jeffs AD, Bortner B, Paterno AV, Dahners L, Draeger RW. 2-Octyl Cyanoacrylate (Dermabond®) Inhibits Bridging Bone Formation of Articular Fractures in a Rat Model. Cureus 2021; 13:e16758. [PMID: 34476134 PMCID: PMC8403484 DOI: 10.7759/cureus.16758] [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] [Accepted: 07/30/2021] [Indexed: 11/05/2022] Open
Abstract
One technique often used for small intraarticular fracture fixation involves the use of 2-octyl-cyanoacrylate (2-OCTA) (Dermabond®, Ethicon, Inc., Raritan, USA). The purpose of this study was to determine if 2-OCTA impedes bony healing. Osteochondral plugs in 38 retired Sprague-Dawley rats were created in both hind legs. Each rat had one plug dipped in 2-OCTA before fixation and one control plug. H&E staining was used to quantify bone bridging. The 2-OCTA group had a mean bridging bone circumference of 22.80%, significantly less than 67.75% in the control group (p<0.05). Our data suggests that 2-OCTA blocks bridging bone formation, making it a poor choice for fracture fixation.
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Affiliation(s)
- Vincent Gomez
- Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Mark Cairns
- Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Paul Weinhold
- Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Alexander D Jeffs
- Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Benjamin Bortner
- Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Anthony V Paterno
- Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Laurence Dahners
- Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Reid W Draeger
- Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
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17
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Fram BR, Seigerman DA, Ilyas AM. Coronal Shear Fractures of the Distal Humerus: A Review of Diagnosis, Treatment, and Outcomes. Hand (N Y) 2021; 16:577-585. [PMID: 31625402 PMCID: PMC8461205 DOI: 10.1177/1558944719878817] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fractures of the capitellum and trochlea are uncommon fractures of the elbow and can be challenging to treat due to their size, location, and articular nature. Because of their intra-articular nature and predilection toward displacement, these fractures are typically treated operatively. Furthermore, capitellum fractures have high rates of associated injuries, including radial head fractures or lateral collateral ligament injury in ~30% to 60% of patients. In addition to open reduction internal fixation, operative options include fragment excision, arthroscopic assisted reduction and fixation, and elbow arthroplasty. In this article, we undertake a comprehensive literature review of capitellum fractures of the distal humerus, in an attempt to summarize the existing body of evidence and propose areas of future study.
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Affiliation(s)
| | | | - Asif M. Ilyas
- Thomas Jefferson University Hospital, Philadelphia, PA, USA,Asif M. Ilyas, Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, 925 Chestnut Street, 5 Floor, Philadelphia PA 19107, USA.
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18
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Borbas P, Vetter M, Loucas R, Hofstede S, Wieser K, Ernstbrunner L. Biomechanical stability of simple coronal shear fracture fixation of the capitellum. J Shoulder Elbow Surg 2021; 30:1768-1773. [PMID: 33529777 DOI: 10.1016/j.jse.2020.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Coronal shear fractures of the capitellum are rare, and their surgical management is challenging, without a defined gold standard. The purpose of this study was to compare the biomechanical stability of 3 different internal fixation techniques for simple coronal shear fractures of the capitellum without posterior comminution. METHODS Dubberley type IA fractures of the capitellum were created in 18 cadaveric elbows, which were age and sex matched to the following 3 internal fixation groups: (1) two anteroposterior cannulated headless compression screws (HCSs), (2) two anteroposterior HCSs with an additional anterior antiglide plate (antiGP), and (3) a posterolateral distal humeral locking plate (LP). All fixation techniques were cyclically loaded with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure. RESULTS Fragment displacement under cyclic loading with 2000 cycles did not show a significant difference (P = .886) between the 3 groups. The HCS group showed the highest stiffness compared with the HCS-antiGP and LP groups (602 N/mm vs. 540 N/mm vs. 462 N/mm, P = .417), without reaching a statistically significant difference. Ultimate load to failure was also not significantly different on comparison of all 3 groups (P = .297). CONCLUSIONS Simple coronal shear fractures of the capitellum are biomechanically equally stabilized by HCSs compared with HCSs with an additional antiGP or a posterolateral distal humeral LP. In view of the advantages of less (invasive) metalware, the clinical use of 2 isolated anteroposterior HCSs appears reasonable.
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Affiliation(s)
- Paul Borbas
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.
| | - Maximilian Vetter
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Rafael Loucas
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Simon Hofstede
- Institute of Biomechanics, Eidgenössische Technische Hochschule Zürich (ETH Zürich), Zürich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
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Li J, Martin VT, Su ZW, Li DT, Zhai QY, Yu B. Lateral epicondyle osteotomy approach for coronal shear fractures of the distal humerus: Report of three cases and review of the literature. World J Clin Cases 2021; 9:4318-4326. [PMID: 34141796 PMCID: PMC8173410 DOI: 10.12998/wjcc.v9.i17.4318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/24/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronal shear fractures of the distal humerus are rare injuries and are technically challenging to manage. Open reduction and internal fixation (ORIF) has become the preferred treatment because it provides anatomical reduction, stable internal fixation, and early motion, but the optimal surgical approach remains controversial.
CASE SUMMARY We report three cases of coronal shear fractures of the distal humerus treated successfully by ORIF via a novel surgical approach, in which lateral epicondyle osteotomy was performed based on the extended lateral approach. We named the novel surgical approach the lateral epicondyle osteotomy approach. All patients underwent surgical treatment and were discharged successfully. All patients had excellent functional results according to the Mayo elbow performance score. The average range of motion was 118° in flexion/extension and 172° in pronation/ supination. Only case 2 had a complication, which was implant prolapse.
CONCLUSION We demonstrated that the lateral epicondyle osteotomy approach in ORIF is effective and safe for coronal shear fractures of the distal humerus.
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Affiliation(s)
- Jie Li
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Vidmi Taolam Martin
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Zhi-Wen Su
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Dong-Tai Li
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Qi-Yi Zhai
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Bo Yu
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
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Mukohara S, Mifune Y, Inui A, Nishimoto H, Kurosawa T, Yamaura K, Yoshikawa T, Waki T, Kuroda T, Niikura T, Kuroda R. Effects of trochlear fragmentation on functional outcome in coronal shear fractures: a retrospective comparative study. JSES Int 2021; 5:571-577. [PMID: 34136873 PMCID: PMC8178597 DOI: 10.1016/j.jseint.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Coronal shear fractures of the distal humerus are rare injuries, and fragmentation of the capitellum and trochlea with posterior comminution is challenging for surgeons. We retrospectively evaluated the functional outcomes of patients with coronal shear fractures managed with open reduction and internal fixation, focusing on the number of trochlea fragments in Dubberley type 3B fractures. Materials and methods The functional outcomes of 25 patients, including 8 patients with type 3B fractures, with a mean age (and standard deviation) of 57 ± 20 years, were evaluated at a mean follow-up duration of 15 ± 9 months. Type 3B fractures were classified into two groups: those with two trochlea fragments or less group (group A) and those with three or more fragments (group B). Patient outcomes were assessed with clinical and radiographic examination, range of motion, and the Mayo Elbow Performance scale (MEPS). Results Two patients with type 3B in group B experienced nonunion, and two patients with type 3B in group A and 1 patient with type 1B demonstrated avascular necrosis on radiographs. The average MEPS score was 96.3 points (range, 70-100), with 18 excellent, 5 good, and 1 fair results. The average range of motion was 10 ± 8 to 130 ± 12. The MEPS score worsened as Dubberley classification progressed from type 1 to type 3 (98.3 vs. 96.7 vs. 88, P = .014, respectively) and subtypes A to B (97.9 vs. 90, P = .014, respectively). In comparing groups A and B, the MEPS score was significantly worse in group B (93.8 vs. 76.3, P = .006). Conclusion Our open reduction and internal fixation results were largely good, although functional outcomes were diminished as Dubberley classification progressed from type 1 to type 3 and subtype A to B. Type 3B fractures with three trochlea fragments or more in the elderly were the most difficult to treat with open reduction and internal fixation and possibly 1-term total elbow arthroplasty.
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Affiliation(s)
- Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Kurosawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Waki
- Department of Orthopedic Surgery, Akashi Medical Center, Akashi, Japan
| | - Tsukasa Kuroda
- Department of Orthopaedic Surgery, Shinsuma Hospital, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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21
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Lu Y, Fu L, Ma T, Xu YB, Xu LP, Song Z, Fan S, Wang Q, Sun L, Xue HZ, Li Z, Zhang K, Liu DY, Ren C. Clinical Efficacy of Vertical or Parallel Technique of a Micro-Locking Plate for Treatment of Dubberley B-Type Capitellar Fractures. Orthop Surg 2021; 13:207-215. [PMID: 33426763 PMCID: PMC7862171 DOI: 10.1111/os.12880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the clinical efficacy of micro‐locking plate through vertical or parallel technique for treatment of Dubberley B‐type capitellar fractures. Methods A retrospective analysis was performed in 24 patients (17 males and seven females, with an average age of 44.9 years, range from 19 to 75 years) with capitellar fractures that were treated with micro‐locking plate using vertical or parallel technique between January 2016 to January 2019. The inclusion criteria include closed capitellar fracture, normal anterior elbow joint movement before injury, and recent capitellar fracture with injury within past 3 weeks. Fractures classified according to Dubberley included four cases of type IB, eight cases of type IIB, and 12 cases of type IIIB. Radiographic evaluation was performed. Surgery time, blood loss, range of motion of the elbow, forearm rotation, and complications were recorded. Elbow joint function was evaluated by Mayo Elbow Performance Score (MEPS). Results The mean follow‐up period was 19.6 months (range, 12–36 months). The average clinical healing time for fractures was 11.2 ± 3.2 weeks (range, 8–20 weeks). Fracture united in all patients. Two patients showed slight delayed union, but union was achieved eventually. The mean time from injury to surgery was 6.3 ± 3.1 days (range, 2–15 days). The average surgical time was 68.1 ± 11.5 min (range, 50–90 min), and the mean blood loss was 75.2 ± 26.5 mL (range, 40–120 mL). The mean range of flexion was 122.5° ± 10.5°(range, 95°–140°). The mean range of extension was 8.5° ± 5.8°(range, 0°–20°). The mean range of pronation was 79.7° ± 8.0°(range, 65°–90°). The mean range of supination was 80.5° ± 7.1°(range, 60°–90°). The mean MEPS at final follow‐up was 89.8 ± 9.0 (range, 60–100). Based on the MEPS, 18 (75%) patients had excellent, five (20.8%) patients had good, and one (4.2%) patient had fair. None of the 24 patients suffered vascular or nerve injury. One patient showed superficial infection, which was treated with surgical dressing. Conclusions The vertical or parallel technique of the micro‐locking plate is an excellent method for treating Dubberley B‐type capitellar fractures.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.,Bioinspired Engineering and Biomechanics Center (BEBC), The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Lei Fu
- Orthopaedics Institute of Chinese PLA, 80th Hospital, Weifang, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.,Bioinspired Engineering and Biomechanics Center (BEBC), The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yi-Bo Xu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Li-Ping Xu
- Orthopaedics Institute of Chinese PLA, 80th Hospital, Weifang, China
| | - Zhe Song
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Shan Fan
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Han-Zhong Xue
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - De-Yin Liu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
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22
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K C KM, Acharya P, Marahatta SB, Sigdel A, K C A, Dahal SC. Functional Outcomes of Capitellum Fractures Treated by Open Reduction and Internal Fixation with Herbert Screw: A Descriptive Cross-sectional Study. ACTA ACUST UNITED AC 2020; 58:775-779. [PMID: 34504371 PMCID: PMC7654489 DOI: 10.31729/jnma.5188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 11/21/2022]
Abstract
Introduction: Based on the complex intra-articular nature of capitellum fractures, it has been sometimes difficult to formulate a universally accepted method of surgical treatment. The purpose of this study is to present the functional outcomes of capitellum fractures after fixation with Herbert screw including the safety and tips of the surgical approach. Methods: This descriptive cross-sectional study was done from December 2014 to November 2019. Ethical approval was taken. The study included 22 capitellum fractures treated by open reduction and internal fixation with Herbert screws either lateral or anterolateral approach. Functional outcomes were assessed with Mayo elbow performance index scores at the latest follow-up visit. Convenient sampling was done. Data entry was done using the Statistical Package for the Social Sciences (version16.0). Results: Out of 22 surgeries, the average time to unite the fracture was 11.13±1.20 weeks (range 9 to 15). The mean range of movement for flexion and extension was 138.41±8.22 degree while the mean supination and pronation range was 161.59±6.79 degree. The average time of follow-up in this series was 37.45±9.43 weeks (range 22 to 58 weeks). Similarly, the mean Mayo elbow performance index score at the latest follow-up was 90.22±8.65 (range 70 to 100). Conclusions: Careful assessment and radiological evaluation, anatomical reduction, and stable fixation with Herbert screws maintaining the minimal damage to the articular cartilage can maximize the functional outcomes and minimize the incidence of complications.
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Affiliation(s)
- Kapil Mani K C
- Department of Orthopedics, Civil Service Hospital, Minbhawan, Kathmandu, Nepal
| | - Parimal Acharya
- Department of Orthopedics, Civil Service Hospital, Minbhawan, Kathmandu, Nepal
| | | | - Arun Sigdel
- Department of Orthopedics, Civil Service Hospital, Minbhawan, Kathmandu, Nepal
| | - Amuda K C
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepa
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Teng L, Zhong G. Surgical Treatment of Comminuted Coronal Shear Fracture of Distal Humerus. Orthop Surg 2020; 12:1439-1447. [PMID: 32979039 PMCID: PMC7670145 DOI: 10.1111/os.12765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate the surgical approach, fixation, and clinical effect of comminuted coronal shear fracture of distal humerus. Methods From March 2017 to February 2019, we had used open reduction and internal fixation to treat 19 cases of comminuted distal humeral coronal shear fracture. There were 8 males and 11 females, with an average age of 44.6 years (19–72 years). There were 10 cases on left side and 9 cases on right side. All cases were closed fractures. According to Dubberley's classification, there were six cases of type 1, six cases of type 2, and seven cases of type 3. The lateral Kocher approach, extended Kocher approach, extended Kocher approach combined with a medial incision and the olecranon osteotomy approach were used for exposure. Headless screw, Kirschner wire, and suture were used to fix the fractures. Two cases were fixed with hinged elbow fixators additionally. The follow‐up was evaluated by Mayo Elbow Performance Score (MEPS). Results All patients were followed up for an average of 17.1 months (range, 12 to 30 months). The average time of fracture union was 8.8 ± 1.9 weeks. There were three cases of degenerative osteoarthritis of elbow and one case of heterotopic ossification after operation. A total of 10 patients underwent removal of implants. At the last follow‐up, the elbow flexion‐extension arc was 130.5° ± 10.5°. The forearm rotation arc was 167.4° ± 6.1°. The MEPS was 85.8 ± 8.5, the results were classified as excellent in nine cases, good in eight, and fair in two. The excellent and good rate was 89.5%. The time of fracture union of type 1 was shorter than type 3 (P = 0.024), the elbow flexion‐ extension arc of type 1 fracture was better than type 2 (P = 0.043) and type 3 (P = 0.012), the forearm rotation arc of type 1 fracture was better than type 3 (P = 0.006), the MEPS of type 1 fracture was better than type 2 (P = 0.009) and type 3 (P = 0.002). Conclusion Open reduction and internal fixation with headless screw, Kirschner wire, and suture can be used for the treatment of comminuted distal humeral coronal shear fractures. The elbow joint function can be restored satisfactorily.
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Affiliation(s)
- Lin Teng
- Department of Orthopedics, The First People's Hospital in Shuangliu District/West China Airport Hospital, Sichuan University, Chengdu, China
| | - Gang Zhong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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24
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Abstract
Multiple techniques have been proposed for metacarpal fracture fixation, including percutaneous Kirschner-wires, interfragmentary screws, plate and screw constructs, intramedullary (IM) nails, and cannulated IM headless screws. Each of these treatment options has its proposed advantages and disadvantages, and there remains no consensus on the optimal mode of treatment. We describe a technique of retrograde IM headless screw fixation for extra-articular metacarpal fractures.
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The anterior limited approach of the elbow for the treatment of capitellum and trochlea fractures: Surgical technique and clinical experience in eight cases. Injury 2020; 51 Suppl 1:S103-S111. [PMID: 32063337 DOI: 10.1016/j.injury.2020.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
When a coronal fracture affects the capitellum and the trochlea, the Kocher lateral approach may be inadequate for the correct visualisation, reduction and fixation of the fracture. In such cases an associated medial elbow approach may be required, or a posterior transolecranon approach may be preferred. The anterior limited approach to the elbow (ALAE) could be a valid option when treating these types of fracture, as it does not involve the detachment of any muscle group or ligament, thereby facilitating the recovery process. We can also treat associated injuries such as fractures of the radial head or coronoid process with this approach. We describe the surgical technique and the functional outcome of eight patients with a mean of 66 years of age (range, 53-76) who where treated with open reduction and internal fixation for capitellar and trochlear fractures through the ALAE. Patient outcomes were assessed with physical and radiological evaluation, range-of-motion measurements with a follow-up from 24 to 60 months. Two different quality of life questionnaires were carried out: the EuroQol Five Dimensions Questionnaire (EQ-5D) and the patient-answered questionnnaire of the Liverpool Elbow Score patient (PAQ-LES). Four fractures involved the capitellum, one involved the capitellum with the lateral ridge of the trochlea, and three involved the capitellum and trochlea as separate fragments. The patients presented a favorable clinical evolution at a median of 33 months (range, 24-60), with an average of motion of 10-138°. Four patients presented a fracture of the head of the radius (Mason type 2) and 3 fractures of the coronoid (Bryan-Morrey Type 1) associated. All the patients presented radiological consolidation without signs of osteonecrosis, being the average EQ-5D 0.857 (range, 0.36-1.0) and the PAQ-LES of 35 (range 17 to 36). Patients with isolated capitellar fractures had better results than those with trochlear involvement. The presence of associated fractures does not seem to worsen the results. We believe that the ALAE is a technical option to consider for the open surgical treatment of a capitellar fracture with or without involvement of the trochlea. LEVEL OF EVIDENCEIS: Therapeutic Level III.
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Abstract
Partial articular fractures involving the capitellum represent an injury to the lateral column of the distal humerus. Capitellum open reduction and internal fixation restores this portion of the distal humerus articular surface and biomechanical integrity to the lateral column. This video demonstrates open reduction and internal fixation of a type I capitellar fracture with headless compression screws through an extensile lateral approach.
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Yu T, Tao H, Xu F, Hu Y, Zhang C, Zhou G. Comparison of lateral approach versus anterolateral approach with Herbert screw fixation for isolated coronal shear fractures of humeral capitellum. J Orthop Surg Res 2019; 14:230. [PMID: 31331352 PMCID: PMC6647071 DOI: 10.1186/s13018-019-1261-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/04/2019] [Indexed: 01/26/2023] Open
Abstract
Background For coronal shear fractures of humeral capitellum, the lateral approach is the most commonly used surgical approach. However, exposure range of the anterior aspect of the distal humerus is inadequate. The anterolateral approach has also been adopted to overcome this disadvantage. However, this approach seems anatomically complex due to the risk of iatrogenic injury to the radial nerve. So far, the optimal approach for the treatment of capitellar shear fractures remains inconclusive. The purpose of this study is to prospectively review and compare the early clinical and radiographic outcomes of treated with open reduction and Herbert screw internal fixation through the lateral approach or the anterolateral approach. Methods Twenty-six patients with isolated capitellar shear fractures were enrolled from January 2013 to December 2017, and randomly assigned to lateral approach group or anterolateral approach group. All the fractures were treated with open reduction and Herbert screw internal fixation through lateral approach or anterolateral approach. Operation time, wound healing complication, elbow joint function, and radiographic evidence were evaluated and compared between two groups. Results The operation via the anterolateral approach took significantly shorter time than via lateral approach (p < 0.05). There were no wound healing problems and infection for both groups. One patient from anterolateral approach group sustained incomplete posterior interosseous nerve palsy, which recovered completely in 4 weeks without residual compromise. All fractures healed well in their normal anatomic position as seen on radiographs. At the final follow-up, no significant difference was found between two groups with respect to the ROM in supination-pronation, ROM in pronation-supination, loss of flexion-extension motion, or loss of pronation-supination motion (p > 0.05). There is no significant difference with respect to MEPI score of elbow joint between two groups (p > 0.05). Conclusion Based on our findings, both lateral approach and anterolateral approach with Herbert screw internal fixation are suitable for coronal shear fractures of capitellum with satisfactory early outcomes. Compared with the lateral approach, the anterolateral approach made the surgical procedure easier and time saving in current series. When the medial aspect of the trochlea is involved for capitellar coronal fractures, the anterolateral lateral approach should be preferred.
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Affiliation(s)
- Tengbo Yu
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China
| | - Hao Tao
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China
| | - Fenglei Xu
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
| | - Yanling Hu
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China.
| | - Chengdong Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China
| | - Guangjie Zhou
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao, Shandong, 266003, People's Republic of China
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Does the presence of posterior comminution modify the treatment and prognosis in capitellar and trochlear fractures? Study performed on 45 consecutive patients. Injury 2018; 49 Suppl 3:S84-S93. [PMID: 30415675 DOI: 10.1016/j.injury.2018.09.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Only few case series of capitellar and trochlear fractures have been reported. Some of them assume that the presence of a posterior comminution (type B according to Dubberley classification) can represent a negative risk factor for treatment and prognosis respect to the type A cases (without posterior comminution). Nevertheless, how this parameter impacts the treatment and the prognosis has never been quantified before. MATERIALS AND METHODS All the capitellar and trochlear fractures treated from 2007 to 2015 have been retrospectively reviewed. The presence of posterior comminution on a pre-operative CT-scan was correlated to the surgical technique, to the timing of initiation of rehabilitation and to clinical outcomes. RESULTS 45 Consecutive patients have been selected, 17 not presenting a posterior comminution (type A), and 28 with posterior comminution (type B). In all the type A fractures a lateral approach (Kocher o Kocher extensile) was used and the fragment fixation was always performed using only screws. Elbow replacement or olecranon osteotomy were performed only to treat type B fractures. Augmented fixations, using plates and k-wires, or prosthetic replacement have been used only in type B fractures. The post-operative immobilization was significantly inferior for type A fracture. Better results have been obtained in type A fractures: mean MEPI score was 86 in type A and 73 in type B, the range of motion was significatively higher in type A both in flexion-extension and in pronation-supination. In type B fractures a significant higher number of complications have been observed (64% vs 29%) along with more reoperations. DISCUSSION The study has confirmed that, even without considering the extension of the fracture on the coronal plane, the presence of posterior comminution represents an evident negative risk factor, influencing the surgical approach and treatment, the fixation technique, the post-operative rehabilitation, the clinical outcomes, the complications and re-operation rates. CONCLUSIONS The analysis of the present case series shows how the treatment and the outcomes can be significantly anticipated based on the presence or absence of posterior comminution. Patients with type A fracture are more likely treated with a Kocher approach, screw fixation, an early rehabilitation is performed. In type A fractures better outcomes and low complications rate are expected.
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Yu T, Tao H, Xu F, Hu Y, Zhang C, Zhou G. Management of isolated coronal shear fractures of the humeral capitellum with Herbert screw fixation through anterolateral approach. BMC Musculoskelet Disord 2018; 19:108. [PMID: 29621984 PMCID: PMC5887211 DOI: 10.1186/s12891-018-2024-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/23/2018] [Indexed: 01/30/2023] Open
Abstract
Background Due to the intraarticular and complex nature of the coronal shear fracture of the humeral capitellum and its rarity, it has been difficult to formulate a universally accepted method of surgical management. The purpose of this study is to retrospectively evaluate the clinical outcomes of 15 patients with isolated coronal shear fractures of the capitellum treated by Herbert screw fixation through anterolateral approach, and to address the safety and tips for this surgical procedure. Methods This retrospective study included 15 isolated coronal shear fractures of the capitellum without posterior involvement, which were classified according to the Dubberley classification as 11 type 1A fractures and 4 type 3A fractures. All fractures were treated with Herbert screws fixation via the anterolateral approach. Clinical and radiographic evaluation was performed regularly, with a mean follow-up of 29 months. Results The mean operative time was 81 min. There were no wound healing problems or infection. One incomplete posterior interosseous nerve injury occurred, which recovered soon without residual compromise. All fractures healed well. At the final follow-up, the average range of motion was 134°in flexion-extension and 172°in supination-pronation. There was no significant difference between the affected and the unaffected elbows with regard to motion in flexion-extension or flexion-extension. The average Mayo Elbow Performance Index Score was 93 with 11 excellent and 4 good. No evidence of avascular necrosis, posttraumatic osteoarthritis, or heterotrophic ossification was found. Conclusion Open reduction and internal fixation using Herbert screws through a anterolateral approach is a reliable and effective treatment for coronal shear fractures of capitellum, and able to achieve stable fixation and restoration of a functional range of motion.
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Affiliation(s)
- Tengbo Yu
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
| | - Hao Tao
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
| | - Fenglei Xu
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
| | - Yanling Hu
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China. .,Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao City, 266003, Shandong Province, China.
| | - Chengdong Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
| | - Guangjie Zhou
- Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China
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Abstract
Objective Fractures of the capitellum are rare injuries but are often more complex and of a greater extent than assumed from conventional radiographs. Classification is usually based on their extension in relation to the trochlea the trochlea and on the number of fragments. Information on associated injuries is limited and only reported in small case series. The aim of this retrospective study was to report on our experience with capitellar fractures and their associated injuries. Methods We retrospectively reviewed all patients treated for fractures of the capitellum humeri at our institute between 2005 and 2017. Fractures were classified according to the Bryan–Morrey and the Dubberley classification and analyzed for their associated injuries depending on the fracture type using the chi-squared test. Results A total of 27 capitellar fractures were treated at our institute between 2005 and 2017. The median age of the patients was 57 years (range, 4–78) and they were all treated operatively. Associated injuries of the elbow were found in 12 cases (ten radial head fractures, two elbow dislocations, two tears of the radial collateral ligament). The injury mechanism was known for 26 patients (four fell on their outstretched arm, 19 suffered a direct blow to their elbow, two had a traffic accident). Conclusion The incidence of radial head fractures is high in patients with capitellar fractures. Patients suffering a fracture of the capitellum humeri should be thoroughly examined for such associated injuries since a missed diagnosis can lead to poor outcomes.
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Resurfacing arthroplasty as an alternative to the posttraumatic sequelae of fractures of the external column of the humerus in the young adult. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Beazley JC, Baraza N, Jordan R, Modi CS. Distal Humeral Fractures-Current Concepts. Open Orthop J 2017; 11:1353-1363. [PMID: 29290875 PMCID: PMC5721312 DOI: 10.2174/1874325001711011353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Distal humerus fractures constitute 2% of all fractures in the adult population. Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation. Methods: A literature search was performed and the authors’ personal experiences are reported. Results: This review has discussed the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we have discussed controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty. Conclusion: Distal humeral fractures are complex injuries that require a careful planned approach, when considering surgical fixation, to restore anatomy and achieve good functional outcomes.
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Affiliation(s)
- James C Beazley
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK
| | - Njalalle Baraza
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK
| | - Robert Jordan
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK
| | - Chetan S Modi
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK
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Aroca-Peinado M, Cecilia-López D, Jiménez-Díaz V. Resurfacing arthroplasty as an alternative to the posttraumatic sequelae of fractures of the external column of the humerus in the young adult. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 62:80-85. [PMID: 29162366 DOI: 10.1016/j.recot.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/09/2017] [Accepted: 09/03/2017] [Indexed: 11/20/2022] Open
Abstract
Symptomatic posttraumatic arthritis of the elbow in young patients is a disorder for which there is currently no satisfactory solution. In this case report we show the evolution of a comminuted fracture of the capitellum with trochlear extension (McKee typeIV) treated initially with open reduction and internal fixation that eventually required a resurfacing hemiarthroplasty of the capitellum and reconstruction of the lateral ligament complex. After this surgical procedure, the patient had evident improvement of pain and of elbow range of motion, keeping the possibility of performing other rescue techniques open if they were to be necessary in the future.
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Affiliation(s)
- M Aroca-Peinado
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - D Cecilia-López
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - V Jiménez-Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
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Headless Compression Screw Versus Kirschner Wire Fixation for Metacarpal Neck Fractures: A Biomechanical Study. J Hand Surg Am 2017; 42:392.e1-392.e6. [PMID: 28359640 DOI: 10.1016/j.jhsa.2017.02.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 01/24/2017] [Accepted: 02/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to determine the biomechanical stability of headless compression screws in the fixation of metacarpal neck fractures and to compare them with another common, less invasive form of fixation, K-wires. The hypothesis was that headless compression screws would show higher stiffness and peak load to failure than K-wire fixation. METHODS Eight matched-paired hands (n = 31), using the ring and little finger metacarpals, had metacarpal fractures simulated at the physeal scar. Each group was stabilized with either a 3.5-mm headless compression screw or 2 0.045-in (1.1-mm) K-wires. Nineteen metacarpals were tested in 3-point bending and 12 in axial loading. Peak load to failure and stiffness were calculated from the load displacement curve. Bone mineral density was recorded for each specimen. RESULTS Bone mineral density was similar in the 2 groups tested for 3-point bending and axial loading. Stiffness was not significantly different in 3-point bending for headless compression screws and K-wires (means, 141.3 vs 194.5 N/mm) but it was significant in axial loading (means, 178.0 vs 111.6 N/mm). Peak load to failure was significantly higher in headless compression screws in 3-point bending (means, 401.2 vs 205.3 N) and axial loading (means, 467.5 vs 198.3 N). CONCLUSIONS Compared with K-wires, headless compression screws for metacarpal neck fractures are biomechanically superior in load to failure, 3-point bending, and axial loading. CLINICAL RELEVANCE Headless compression screws demonstrate excellent biomechanical stability in metacarpal neck fractures. In conjunction with promising clinical studies, these data suggest that headless compression screws may be an option for treating metacarpal neck fractures.
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Frank JM, Saltzman BM, Garbis N, Cohen MS. Articular shear injuries of the capitellum in adolescents. J Shoulder Elbow Surg 2016; 25:1485-90. [PMID: 27364145 DOI: 10.1016/j.jse.2016.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/25/2016] [Accepted: 03/13/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fractures of the capitellum are rare and are commonly classified into 4 types. Type II variants involve a shear injury with a mostly articular cartilage component and little subchondral bone. Symptoms upon presentation after these injuries are variable, and the diagnosis can be difficult to make in the immature skeleton. METHODS We retrospectively reviewed 3 cases of type II capitellar fractures in adolescent athletes who presented for evaluation with the senior author. RESULTS All patients were initially treated conservatively, without identification or treatment of the capitellar shear component of their injury. Unfortunately, radiocapitellar arthrosis rapidly developed in all 3 and required surgical intervention at our institution. At an average postoperative follow-up of 49 months from the index procedure, patients ultimately had positive outcomes despite advanced degenerative changes on imaging. One patient required 2 subsequent operations for mechanical symptoms and pain. DISCUSSION The 3 reported cases represent adolescent, athletic patients with missed shear injuries to the capitellum. These patients exhibited low Disabilities of Arm, Shoulder and Hand scores and high Mayo Elbow Performance Scores at final follow-up, but each patient demonstrated advanced degenerative changes on imaging, and 1 patient required 2 subsequent operations for mechanical symptoms and pain. A high index of suspicion is necessary to identify this injury pattern, and proper plain radiographic imaging with a low threshold for advanced imaging is necessary. Although the overall long-term prognosis is unknown for these patients, early recognition likely would have changed the initial conservative management decision in each and, theoretically, might have altered the outcome for these patients.
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Affiliation(s)
| | - Bryan M Saltzman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Nickolas Garbis
- Department of Orthopedic Surgery and Rehabilitation, Loyola University, Maywood, IL, USA
| | - Mark S Cohen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Sukegawa K, Suzuki T, Ogawa Y, Ueno K, Kiuchi H, Kanazuka A, Matsuura Y, Kuniyoshi K. Anatomic cadaveric study of the extensile extensor digitorum communis splitting approach for exposing the ulnar coronoid process. J Shoulder Elbow Surg 2016; 25:1268-73. [PMID: 27032618 DOI: 10.1016/j.jse.2016.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/23/2015] [Accepted: 01/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The extensile extensor digitorum communis (EDC) splitting approach can access the ulnar coronoid process (UCP), which can be used to treat terrible triad injuries. The present study anatomically examined the extensile EDC splitting approach for exposing the UCP. METHODS Twenty fresh frozen cadaveric upper limbs were dissected. The splitting length of the EDC and detachment length of the extensor carpi radialis brevis (ECRB)-extensor carpi radialis longus (ECRL)-brachioradialis (BR) origin were measured to expose the UCP. The distance between the most distal site of the EDC splitting and the point at which the posterior interosseous nerve (PIN) crosses the anterior aspect of the radial shaft, and the distance between the most proximal site of the ECRB-ECRL-BR origin detachment and the point at which the radial nerve crosses the anterior aspect of the humeral shaft were measured. RESULTS The splitting length of the EDC was 45.4 ± 4.8 mm, the detachment length of the ECRB-ECRL-BR origin was 30.2 ± 4.7 mm, the distance between the distal site of the EDC splitting and PIN was 10.6 ± 6.1 mm (minimum distance, 1.1 mm), and the distance between the proximal site of the ECRB-ECRL-BR origin detachment and the radial nerve was 49.5 ± 9.7 mm (minimum distance, 31.7 mm). CONCLUSIONS The extensile EDC splitting approach can sufficiently expose the UCP. However, splitting must be performed carefully because the most distal site of the EDC splitting is close to the point at which the PIN crosses the anterior aspect of the radial shaft (average distance, 10 mm; minimum distance, 1 mm).
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Affiliation(s)
- Koji Sukegawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan.
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Yasufumi Ogawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Keisuke Ueno
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Hitoshi Kiuchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Aya Kanazuka
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Kazuki Kuniyoshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
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Open reduction and internal fixation of capitellar fracture through anterolateral approach with headless double-threaded compression screws: a series of 16 patients. J Shoulder Elbow Surg 2016; 25:1182-8. [PMID: 27052272 DOI: 10.1016/j.jse.2016.01.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/14/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fracture of the capitellum is an often missed or inadequately treated serious elbow injury. Anatomic reduction and proper stabilization are essential to obtain articular congruity so that late-onset arthritis can be avoided. The main areas of interest in this intriguing fracture are the choice of implant and the surgical approach. We describe the use of anterolateral approach and headless double-threaded compression screws for the fixation of this fracture. MATERIALS AND METHODS This prospective study included 16 capitellar fractures. A computed tomography scan was done for delineating the fracture line and planning the fixation technique. All fractures were treated with headless double-threaded compression screws using an anterolateral approach, over a period of 3 years, with a mean follow-up of 2.3 years (range, 1.5-4 years). RESULTS The average time to bony union was 3.5 months (range, 2.5-5 months) with no malunion or nonunion. The mean range of flexion was 132° (range, 125°-135°). The average extensor lag was 10° (range, 0°-25°), but the range of motion remained functional in all patients. On the final follow-up, no evidence of osteonecrosis, post-traumatic osteoarthritis, or heterotrophic ossification was seen. The outcome was excellent in 10 patients, and 6 patients had a good result. CONCLUSIONS The success of management of a capitellar fracture depends on an early diagnosis by keeping a high index of suspicion and timely management. Adequate exposure of the fracture is of paramount importance to achieve accurate reduction. This can be satisfactorily achieved by an anterolateral approach to the elbow. An adequate fixation of the fractured fragments can be achieved by the use of headless double-threaded compression screws.
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Clinical outcome and osteoarthritic changes after surgical treatment of isolated capitulum humeri fractures with a minimum follow-up of five years. INTERNATIONAL ORTHOPAEDICS 2016; 40:2603-2610. [PMID: 27040553 DOI: 10.1007/s00264-016-3165-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/06/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of this study was to evaluate the functional outcome of patients treated for a fracture of the capitulum humeri and to analyze the grade of osteoarthritic changes. METHODS Patients undergoing surgical reconstruction of isolated capitulum humeri fractures were included in a retrospective comparative analysis. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) and Dubberley and were functionally evaluated by the American Shoulder and Elbow Surgeons Score (ASES) and the Mayo Elbow Performance Index (MEPI). Levels of arthritic changes were measured with the Broberg and Morrey Score. Frequency of complications was evaluated whereby all results were compared to the ipsilateral, unaffected side. RESULTS Thirteen patients, ten females (76.9 %) and three males (23.1 %), with a mean age of 48.7 ± 13.3 years were included in the study. Long-term follow-up range of motion (ROM) in the sagittal plane was significantly influenced by time of surgery (p < 0.001), and long-term follow-up with respect to pronation and supination by ROM of the healthy control (p < 0.05). The average ASES score was 37.8, and the Mayo Elbow Performance Index (MEPI) was 92.7. The mean level of degenerative arthritic changes was 1.9 ± 0.6 on the fractured side and significantly less (0.8 ± 0.8) on the healthy side (pF-test < 0.001). At a mean follow-up of 118.5 ± 52.4 months neither nonunion nor avascular necrosis were observed in any case. However, six cases of heterotopic ossification were identified. CONCLUSIONS Satisfying functional outcomes and a low rate of osteoarthritic changes can be expected after the presented open reduction and internal fixation of capitulum humeri fractures. LEVEL OF EVIDENCE Level IV - Case series; therapeutic study.
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Lopiz Y, Rodríguez-González A, García-Fernández C, Marco F. Open reduction and internal fixation of coronal fractures of the capitellum in patients older than 65 years. J Shoulder Elbow Surg 2016; 25:369-75. [PMID: 26927432 DOI: 10.1016/j.jse.2015.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/28/2015] [Accepted: 12/04/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to describe the fracture patterns of capitellum coronal fractures and to evaluate the complications and functional and radiographic outcomes of open reduction and internal fixation in patients older than 65 years. METHODS A retrospective study of 23 patients with a mean follow-up of 48 months (36-105) was performed. Fractures were classified according to the Dubberley classification. All patients were evaluated by the Mayo Elbow Performance Index (MEPI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS Three patients were lost to follow-up. There were 16 type 1 and 4 type 2 fractures. The mean age was 71 years (66-79), and 65% were women. The mean MEPI score was 92 (60-100), and the mean DASH score was 9 (0-75). Either a concomitant fracture or an elbow dislocation was present in 50% of the patients. Mean sagittal plane range of motion at last follow-up was 122° ± 8°, with lower extension in type 2 and worse scores on MEPI (91 vs. 97) and DASH (3 vs. 0) scales. Placement of the screws in the posteroanterior direction was associated with better range of motion in flexion (130° vs. 122°) and better outcomes in functional scores (MEPI, 97 vs. 89; QuickDASH, 0 vs. 4). Complications were post-traumatic osteoarthritis in 3 patients, avascular necrosis in 1 patient, and heterotopic ossification in 5 patients. One patient required reoperation. CONCLUSIONS Patients older than 65 years have no substantial risk of complex fracture patterns, but they have a large number of concomitant injuries. Open reduction and internal fixation with cannulated screws allow stable fixation and provide satisfactory functional results with a lower complication rate.
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Affiliation(s)
- Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain.
| | - Alberto Rodríguez-González
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain
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Abstract
Fractures of the capitellum and trochlea account for a small proportion of elbow trauma. Clinicians need to be vigilant in their assessment as they are commonly associated with other injuries about the elbow. To optimize outcomes, the goals of management include a stable, anatomic reduction and early range of motion. Closed reduction of noncomminuted fractures may be successful but requires close follow-up. Open reduction and internal fixation is the preferred management of displaced capitellum-trochlear fractures. Elbow stiffness is the most commonly reported complication in operatively treated fractures. Arthroscopic-assisted reduction and internal fixation and arthroplasty are evolving management options.
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Affiliation(s)
- Michael J Carroll
- Division of Orthopedic Surgery, Roth|McFarlane Hand & Upper Limb Centre, St. Joseph's Health Center, Western University, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada
| | - George S Athwal
- Division of Orthopedic Surgery, Roth|McFarlane Hand & Upper Limb Centre, St. Joseph's Health Center, Western University, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada
| | - Graham J W King
- Division of Orthopedic Surgery, Roth|McFarlane Hand & Upper Limb Centre, St. Joseph's Health Center, Western University, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada
| | - Kenneth J Faber
- Division of Orthopedic Surgery, Roth|McFarlane Hand & Upper Limb Centre, St. Joseph's Health Center, Western University, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada.
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Yu SY, Wang W, Liu S, Ruan HJ, Liu JJ, Li XJ, Zhan YL, Fan CY. Arthrolysis and delayed internal fixation combined with hinged external fixation for elbow stiffness associated with malunion or nonunion of capitellum fracture. J Shoulder Elbow Surg 2015; 24:941-6. [PMID: 25818519 DOI: 10.1016/j.jse.2015.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/22/2015] [Accepted: 01/31/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study assessed outcomes after treatment of patients with capitellum fracture diagnosed >4 weeks after the trauma (delayed) who presented with stiff elbow. METHODS We reviewed 7 patients with stiff elbows after delayed diagnosis of capitellum fractures between February 2007 and February 2012. They were treated with arthrolysis by twin incisions, late open reduction and internal fixation, and a hinged external fixator. According to the Bryan-Morrey-McKee classification, 3 patients had type I capitellum fractures and 4 patients had type IV. RESULTS Mean follow-up was 28 months (range, 24-38 months). The mean delay from the initial trauma was 3.7 months. The flexion arc improved from a preoperative mean of 24° to a postoperative mean of 122°. The Mayo Elbow Performance Score increased from a mean of 56 points to 93 points. Anatomic fracture union occurred in all cases, and there was no secondary displacement. CONCLUSIONS Arthrolysis, late internal fixation, and use of a hinged external fixator can solve problems associated with stiff elbow after delayed diagnosis of capitellum fracture. Combined use of these techniques may be a safe and effective treatment option.
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Affiliation(s)
- Shi-Yang Yu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Wang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shen Liu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hong-Jiang Ruan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun-Jian Liu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xu-Jun Li
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yu-Lin Zhan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cun-Yi Fan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Yari SS, Bowers NL, Craig MA, Reichel LM. Management of distal humeral coronal shear fractures. World J Clin Cases 2015; 3:405-417. [PMID: 25984515 PMCID: PMC4419104 DOI: 10.12998/wjcc.v3.i5.405] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 01/15/2015] [Accepted: 02/11/2015] [Indexed: 02/05/2023] Open
Abstract
Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface following distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach (direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails.
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Ruchelsman DE, Puri S, Feinberg-Zadek N, Leibman MI, Belsky MR. Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures. J Hand Surg Am 2014; 39:2390-5. [PMID: 25240434 DOI: 10.1016/j.jhsa.2014.08.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless compression screw (IMHS) fixation for metacarpal neck and shaft fractures. METHODS Retrospective review of prospectively collected data on a consecutive series of 39 patients (34 men; 5 women), mean age 28 years (range, 16-66 y) treated with IMHS fixation for acute displaced metacarpal neck/subcapital (N = 26) and shaft (N = 13) fractures at a single academic practice between 2010 and 2014. Preoperative magnitude of metacarpal neck angulation averaged 54° (range, 15° to 70°), and shaft angulation averaged 38° (range, 0° to 55°). Patients used a hand-based orthosis until suture removal and began active motion within the first week. Clinical outcomes were assessed with digital goniometry, pad-to-distal palmar crease distance, and grip strength. Time to union and radiographic arthrosis was assessed. Twenty patients reached minimum 3-month follow-up, with a mean of 13 months (range, 3-33 mo). RESULTS All 20 patients with minimum 3 months of follow-up achieved full composite flexion, and extensor lag resolved by 3-week follow-up. All patients demonstrated full active metacarpophalangeal joint extension or hyperextension. Grip strength measured 105% (range, 58% to 230%) of the contralateral hand. No secondary surgeries were performed. There were 2 cases of shaft re-fracture from blunt trauma following prior evidence of full osseous union with the screw in place. All patients achieved radiographic union by 6 weeks. There was no radiographic arthrosis at latest follow-up. One patient reported occasional clicking with metacarpophalangeal joint motion not requiring further treatment. CONCLUSIONS Limited open retrograde IMHS fixation proved to be safe and reliable for metacarpal neck/subcapital and axially stable shaft fractures, allowed for early postoperative motion without affecting union rates, and obviated immobilization. This technique offers distinct advantages in select patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- David E Ruchelsman
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA.
| | - Sameer Puri
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
| | - Natanya Feinberg-Zadek
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
| | - Matthew I Leibman
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
| | - Mark R Belsky
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
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44
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Headless bone screw fixation for combined volar lunate facet distal radius fracture and capitate fracture: case report. J Hand Surg Am 2014; 39:1489-93. [PMID: 24814242 DOI: 10.1016/j.jhsa.2014.03.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 02/02/2023]
Abstract
We report a case of concomitant fractures of the volar lunate facet of the distal radius and capitate body. Surgical fixation was achieved with open reduction internal fixation using headless compression screws for both fractures. Because of the nature of complications seen after both operative and nonsurgical management, these fractures warrant particular attention.
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Kharbanda Y, Sharma M, Vadhera A, Srivastava V. Internal fixation of fractures of the capitellum and trochlea – Retrospective analysis of 26 cases. APOLLO MEDICINE 2013. [DOI: 10.1016/j.apme.2013.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Kurtulmus T, Saglam N, Saka G, Avci CC, Kucukdurmaz F, Akpinar F. Posterior fixation of type IV humeral capitellum fractures with fully threaded screws in adolescents. Eur J Trauma Emerg Surg 2013; 40:379-85. [PMID: 26816075 DOI: 10.1007/s00068-013-0332-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 09/07/2013] [Indexed: 01/30/2023]
Abstract
PURPOSE Humeral capitellum fractures comprise approximately 1% of all elbow fractures. In this study, we examined the clinical, radiographic, and functional outcomes following operative stabilization of Bryan and Morrey type IV fractures of the capitellum in adolescents. We applied headless cannulated screws in a posteroanterior direction without damaging the articular cartilage surface of the fractures. METHODS Eight adolescent patients (six male, two female) with a mean age of 15 ± 2.1 years (range 13-18 years) were treated for type IV (McKee) humerus capitellum fractures. In the preoperative radiological evaluation, anteroposterior and lateral radiographs and computed tomography (CT) images were performed. A lateral surgical approach was used, and cannulated fully threaded headless screws were applied in a posteroanterior direction as fixation materials in the fracture reduction. The Mayo Elbow Performance Score was used in the evaluation of elbow joint functions. RESULTS Patients were followed up for a mean of 24.6 months. Fracture union was achieved at a mean of 5 ± 0.92 weeks (range 4-6 weeks). The mean elbow extension flexion arc was 135° ± 13.47° (range 110°-150º) and the mean pronation supination arc was 156° ± 4.43° (150°-160°). In one patient, there was nonconformity in the humerus trochlea and in another patient, there was keloid formation on the surgical scar. All patients attained excellent results according to the Mayo Elbow Performance Score. CONCLUSIONS In the treatment of type IV capitellum fractures in adolescents, open reduction with a lateral surgical approach and fixation using posteroanterior directed, cannulated, fully threaded, headless screws is a reliable method to achieve a pain-free functional elbow joint.
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Affiliation(s)
- T Kurtulmus
- Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey.
| | - N Saglam
- Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - G Saka
- Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - C C Avci
- Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - F Kucukdurmaz
- Faculty of Medicine, Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - F Akpinar
- Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
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Bilsel K, Atalar AC, Erdil M, Elmadag M, Sen C, Demirhan M. Coronal plane fractures of the distal humerus involving the capitellum and trochlea treated with open reduction internal fixation. Arch Orthop Trauma Surg 2013; 133:797-804. [PMID: 23494115 DOI: 10.1007/s00402-013-1718-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Coronal plane fractures of the distal humerus involving the capitellum and trochlea are rare. Treatments have evolved from closed reduction to open reduction and internal fixation (ORIF) to achieve a stable joint that allows early mobilization. BACKGROUND We determined the functional outcomes of treating coronal plane fractures of the distal humerus with ORIF. METHODS We reviewed the records of all patients with coronal plane fractures of the distal humerus treated by ORIF. Fractures were classified according to Bryan and Morrey. Cannulated screws were used for fixation. All patients were evaluated using the Mayo Elbow Score Performance Index (MEPI) and disabilities of the arm, shoulder, and hand (DASH) scores at least 1 year later. RESULTS Of the 18 patients evaluated (12 women), the mean (SD) age was 45.3(16.5) years (range 16-70). There were seven Type-I, five Type-III, and six Type-IV fractures. Mean follow-up was 43.6 (38.1) months (range 12-120). The mean elbow range of motion in sagittal plane at last follow-up ranged from 8.9° to 132.8°. The mean MEPI score was 86.7 (15.2) points (range 60-100), corresponding to 12 excellent, 2 good, and 4 fair outcomes. The mean DASH score was 15.3 (13.5) points (range 17-35.8). Heterotrophic ossification developed in one patient with delayed fixation; 14 patients with excellent or good results returned to their previous activity levels. Functional scores did not differ by age, sex, or fracture types (P > 0.05 for all comparisons). CONCLUSION ORIF with cannulated screws, which maintain a stable anatomic articular position, provides satisfactory results in coronal plane fractures of the distal humerus. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Kerem Bilsel
- Orthopaedic and Traumatology Department, Bezmialem Vakif University, Fatih, 34093, Istanbul, Turkey.
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Jeevannavar SS, Shenoy KS, Daddimani RM. Corrective osteotomy through fracture site and internal fixation with headless screws for type I (Hahn-Steinthal) capitellar malunion. BMJ Case Rep 2013; 2013:bcr-2013-009230. [PMID: 23709538 DOI: 10.1136/bcr-2013-009230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A 20-year-old woman presented 6 months after an initial injury to her left elbow with pain and restricted movements. She was diagnosed with a type I malunited (Hahn-Steinthal) type of capitellum fracture through radiographic studies. Classically, the treatment has been excision of the fragment, which carries a risk of valgus instability of the elbow and late osteoarthrosis. We report a case of malunited type I capitellum fracture, for which corrective osteotomy through fracture site, open reduction and internal fixation was done 6 months following missed trauma. At 24 months follow-up the capitellum fracture had united and the patient has a stable elbow and excellent range of motion. Our case demonstrates that for type I malunited capitellum fractures corrective osteotomy through fracture site and internal fixation rather than excision of the fragment in young can result in successful union and stable elbow.
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Distal humeral coronal plane fractures: management, complications and outcome. J Shoulder Elbow Surg 2013; 22:560-6. [PMID: 22981357 DOI: 10.1016/j.jse.2012.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 07/13/2012] [Accepted: 07/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Coronal plane fractures of the distal humerus have special characteristics in classification, imaging, surgical approaches, materials used, treatment modalities, and complications. The purpose of this study is to comment on these topics. MATERIALS AND METHODS A retrospective analysis was done for patients with distal humeral coronal plane fractures. They were classified according to Dubberley and functionally evaluated by Mayo Elbow Performance Index (MEPI). The long-term complications were evaluated. RESULTS There were 15 patients, with type 1 fractures in 2, type 2 in 6, and type 3 in 7. All patients were treated by open reduction and internal fixation either by lateral or posterior approach. The average MEPI score was 83.3 (range, 60-100) points with 7 excellent, 2 good, and 6 fair results. The MEPI scores of type 3 fractures were significantly lower than those of types 1 and 2 fractures (P = .037 and P = .002, respectively). The complications were avascular necrosis in 4 (27%) patients, degenerative arthritis in 6 (40%), joint step-off in 6 (40%), heterotopic ossification in 7 (47%), nonunion in 1 (7%), and implant failure in 1 (7%). The presence of avascular necrosis and joint step-off were significantly associated with degenerative arthritis (P = .004 and P = .005, respectively). Heterotopic ossification was significantly associated with presence of lateral epicondyle fracture (P = .004). CONCLUSION Type 1A and 2A coronal plane fractures typically had an excellent outcome. However, type 3 and subtype B fractures are prone to developing complications which are primarily avascular necrosis, degenerative arthritis and heterotopic ossification.
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ten Berg PWL, Mudgal CS, Leibman MI, Belsky MR, Ruchelsman DE. Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures. J Hand Surg Am 2013. [PMID: 23200214 DOI: 10.1016/j.jhsa.2012.09.029] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Fixation countersunk beneath the articular surface is well accepted for periarticular fractures. Limited open intramedullary headless compression screw (HCS) fixation offers clinical advantages over Kirschner wire and open techniques. We used quantitative 3-dimensional computed tomography to assess the articular starting point, surface area, and subchondral volumes used during HCS fixation of metacarpal neck fractures. METHODS We simulated retrograde intramedullary insertion of 2.4- and 3.0-mm HCS and 1.1-mm Kirschner wires for metacarpal neck fracture fixation in 3-dimensional models from 16 adults. We used metacarpal head articular surface area (mm(2)) and subchondral volumes (mm(3)) and coronal and sagittal plane arcs of motion, during which we analyzed the center and rim of the articular base of the proximal phalanx engaging the countersunk entry site. RESULTS Mean metacarpal head surface area mated to the proximal phalangeal base in neutral position was 93 mm(2); through the coronal plane arc (45°) was 129 mm(2), and through the sagittal plane arc (120°) was 265 mm(2). The mean articular surface area used by countersunk HCS threads was 12%, 8%, and 4%, respectively, in each of these arcs. The 1.1-mm Kirschner wire occupied 1.2%, 0.9%, and 0.4%, respectively. Mean metacarpal head volume was 927 mm(3). Mean subchondral volume occupied by the countersunk portion was 4%. The phalangeal base did not overlap the dorsally located countersunk entry site through most of the sagittal plane arc. During coronal plane motion in neutral extension, the center of the base never engaged the dorsally located countersunk entry site. CONCLUSIONS Metacarpal head surface area and subchondral head volume occupied by HCS were minimal. Articular surface area violation was least during the more clinically relevant sagittal plane arc of motion. CLINICAL RELEVANCE The dorsal articular starting point was in line with the medullary canal and avoided engaging the center of the articular base through most of the sagittal plane arc. Three-dimensional computed tomography data support the use of an articular starting point for these extra-articular fractures.
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Affiliation(s)
- Paul W L ten Berg
- Hand and Upper Extremity Surgery Service, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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