Review Question - QID 217409

This patient sustained a capitellum fracture. The most common complication following this injury is elbow contracture/stiffness.

Capitellum fractures are traumatic intra-articular elbow injuries involving the distal humerus at the capitellum. Diagnosis is made using plain radiographs of the elbow. Treatment may be nonoperative for nondisplaced fractures, but any displacement generally requires anatomic open reduction and internal fixation. Elbow contracture/stiffness is the most complication following this injury.

Murthy et al. retrospectively reviewed capitellar fractures in the pediatric population. They proposed a classification system for these injuries in this cohort. They reported that nondisplaced fractures heal successfully with cast immobilization. They concluded that timely surgical management for displaced injuries is recommended to optimize clinical results.

Vaishya et al. reviewed the use of anterolateral approach and headless double-threaded compression screws for the fixation of pediatric capitellar fractures. They reported that the success of a capitellar fracture depends on an early diagnosis and timely management. They concluded that adequate exposure of the fracture is of paramount importance to achieve accurate reduction and may be achieved by an anterolateral approach to the elbow. Moreover, an adequate fixation of the fractured fragments can be achieved by the use of headless double-threaded compression screws.

Ring et al. retrospectively reviewed distal humeral articular fractures and analyzed the results of open reduction and internal fixation of these injuries. Of 21 cases, they reported that 10 patients required a second operation: 6 for release of an elbow contracture; 2 for treatment of ulnar neuropathy; 1 for removal of hardware causing symptoms; and 1 because of early loss of fixation. There was no residual ulnohumeral instability or weakness in any patient. They concluded that fractures of the capitellum are often more complex fractures of the articular surface of the distal part of the humerus and treatment of these injuries with operative reduction and fixation with buried implants can result in satisfactory restoration of elbow function.

Figure A is the radiograph of the elbow demonstrating a displaced capitellar fracture with extension into the trochlea

Incorrect Answers:
Answer 1: The risk of AVN of the capitellum requiring reoperation is much less common than elbow contracture/stiffness
Answer 2: The risk of cubital valgus requiring reoperation is much less common than elbow contracture/stiffness
Answer 4: The risk of heterotopic ossification is approximately 4% following ORIF and requires reoperation less commonly than elbow contracture/stiffness
Answer 5: The risk of nonunion is approximately 1-11% following ORIF and requires reoperation less commonly than elbow contracture/stiffness