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The double arc sign demonstrated in Figure A is considered a pathognomonic of a capitellar coronal shear fracture. Capitellar coronal shear fractures often are treated with headless compression screws to prevent intra-articular prominence of the screws (Figure A). During fixation of capitellar coronal shear fractures, headless screws are useful because this is often a partial articular injury and anterior to posterior screw placement may require going through the articular surface. The anterior entry of the screw should be buried beneath the articular cartilage margin to prevent prominence and possible damage to the radial head. Screw trajectory in other directions risks poor compression across the fracture site. McKee et al. investigated coronal shear fractures of the distal end of the humerus. They reported that all patients were treated with open reduction internal fixation, with early elbow motion allowed. They highlighted that all patients had good/excellent functional results according to the elbow-rating scale of Broberg and Morrey. Stamatis et al. retrospectively reviewed the treatment and functional outcome of coronal shear fractures of the distal humerus. They reported that all fractures healed within 6 to 9 weeks with a single case of osteonecrosis and post-traumatic arthritis, with preservation of muscle strength of the major muscle groups of the operated elbow compared to the uninjured elbow. They concluded that recognition of coronal capitellar fractures, prompt treatment with anatomic reduction and internal fixation, and early rehabilitation can lead to excellent functional outcomes. Durakbasa et al. investigated the management, complications, and outcomes after distal humeral coronal plane fractures. They reported that all patients were treated by open reduction and internal fixation. They highlighted the complications including avascular necrosis (27%), degenerative arthritis (40%), joint step-off (40%), heterotopic ossification (47%), nonunion (7%), and implant failure (7%). Illustration A depicts a lateral radiograph of a capitellar shear fracture treated with headless compression screws. Incorrect Answers: Answer 2: This depicts a lateral condyle fracture, often treated with open reduction with percutaneous pinning or internal fixation with a headed screw. Answer 3: This depicts a medial epicondyle fracture, often treated with a headed compression screw with or without a washer. Answer 4: This depicts an olecranon fracture, often treated with a plate and screw construct or tension-band wiring. Answer 5: This depicts an extra-articular supracondylar distal humerus fracture. These are often treated with plate and screw fixation or in younger patients percutaneous pinning.
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