TO THE EDITOR:
In "Coronal Shear Fractures of the Distal End of the Humerus" (78-A: 49—54, Jan. 1996), McKee et al. identified the isolated displaced fracture of the capitellum and a part of the trochlea as a newly described fracture.
This exact type of fracture was described by Mouchet in 1898 and by Kocher in 1904, as stated by Judet et al.1 (my grandfather, father, and uncle). A review of this text reveals the lesion described by McKee et al. to be precisely represented by a linear drawing and a photograph of a specimen. It should be noted as well that the only treatment proposed was removal of the fragment.
Nevertheless, the series presented by McKee et al. is of great interest because it confirms the good and excellent results achieved with operative treatment, followed by active early rehabilitation, of these infrequent fractures.
My only concern regards this historical detail.
T. Judet: Hôpital Tenon, 4, rue de la Chine, 75970 Paris CEDEX 20, France
Dr. McKee, Dr. Jupiter, and Dr. Bamberger reply:
We thank Professor Judet for bringing the previous description of a fracture of the distal end of the humerus involving the capitellum and a major portion of the trochlea to our attention. Interestingly, the diagram clearly shows a very similar (if not identical) fracture, with the so-called double-arc sign illustrating the subchondral bone of the capitellum and trochlea in profile as the fragment migrates proximally and rotates.
We believe that that article and ours are complementary in that ours describes excellent results with open reduction and internal fixation of this fragment compared with operative excision, as was described in the text cited by Professor Judet1.
We are glad that we were able to expand the recognition and treatment of this rather infrequent lesion, and we thank Professor Judet for his interest.
Michael D. McKee, M.D., F.R.C.S.(C): Upper Extremity Service, St. Michael's Hospital Orthopaedic Associates, 55 Queen Street East, Suite 800, Toronto, Ontario M5C 1R6, Canada
Jesse B. Jupiter, M.D.: Orthopaedic Hand Service, Massachusetts General Hospital, Harvard University, 14 Fruit Street, Boston, Massachusetts 02114
H. Brent Bamberger, D.O.: Orthopaedic Associates of Southwestern Ohio, 425 West Grand Avenue, Suite 1003, Dayton, Ohio 45405