Capitellar Fracture

synonyms:

Capitellar Fracture ICD-9

• 812.44 (fracture of humerus, condyle unspecified, articular process NO, lower epiphysis)

Capitellar Fracture Etiology / Epidemiology / Natural History

• Isolated capitellar fractures are uncommon.
• Women < men
• Mechanism of injury: When elbow is hyperextended the radial head forcefully shears off the capitellum during posterior dislocation.

Capitellar Fracture Anatomy

• Capitellar fractures often have extension into the trochlea (Buitton TG, JBJS 2009;91A:390).
• see Elbow Anatomy.

Capitellar Fracture Clinical Evaluation

• Pain, swelling, deformity, loss of motion.
• Document NV exam.
• Evaluate for compartment syndrome.

Capitellar Fracture Xray / Diagnositc Tests

• A/P, lateral and oblique views of the elbow demonstrate fracture.
• CT scan: typically indicated to fully asses fracture. 3D reconstructions with radius and ulna subtracted are beneficial.

Capitellar Fracture Classification / Treatment

• Type I (Hahn-Steinthal / capitellar shear fracture): ORIF
• Type II (Kocher-Lorenz / cartilage and thin layer of subchondral bone sheared off): arthroscopic fragment excision +/- microfracture
• Type III (comminution or compression of the articular surface): arthroscopic fragment excision +/- microfracture.

Capitellar Fracture Associated Injuries / Differential Diagnosis

• Posterior elbow dislocation
• Radial head fracture
• Distal humerus fracture
• Trochlear fracture

Capitellar Fracture Complications

• Post-Traumatic arthritis
• Contracture

Capitellar Fracture Follow-up Care

• Post-op: compressive dressing, elevation
• 1 week: Start PT focused on ROM and strengthening. AAROM, PROM.  AROM, free weights start at 3 weeks.
• 6 weeks: progressive sport specific activity.
• 3 months: Return to sport / full activities.
• Elbow scope rehab protocol.
• Elbow Outcome measures.

Capitellar Fracture Review References

• Rockwood and Green's Fractures in Adults 6th ed, 2006
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