BACKGROUND: The outcome of operatively treated capitellar fractures
has not been reported frequently. The purpose of the present study was to
evaluate the clinical, radiographic, and functional outcomes following open
reduction and internal fixation of capitellar fractures that were treated with
a uniform surgical approach in order to further define the impact on the
outcome of fracture type and concomitant lateral column osseous and/or
METHODS: A retrospective evaluation of the upper extremity database
at our institution identified sixteen skeletally mature patients (mean age, 40
± 17 years) with a closed capitellar fracture. In all cases, an
extensile lateral exposure and articular fixation with buried cannulated
variable-pitch headless compression screws was performed at a mean of ten days
after the injury. Clinical, radiographic, and elbow-specific outcomes,
including the Mayo Elbow Performance Index, were evaluated at a mean of 27
± 19 months postoperatively.
RESULTS: Six Type-I, two Type-III, and eight Type-IV fractures were
identified with use of the Bryan and Morrey classification system. Four of
five ipsilateral radial head fractures occurred in association with a Type-IV
fracture. The lateral collateral ligament was intact in fifteen of the sixteen
elbows. Metaphyseal comminution was observed in association with five
fractures (including four Type-IV fractures and one Type-III fracture).
Supplemental mini-fragment screws were used for four of eight Type-IV
fractures and one of two Type-III fractures. All fractures healed, and no
elbow had instability or weakness. Overall, the mean ulnohumeral motion was
123° (range, 70° to 150°). Fourteen of the sixteen patients
achieved a functional arc of elbow motion, and all patients had full forearm
rotation. The mean Mayo Elbow Performance Index score was 92 ± 10
points, with nine excellent results, six good results, and one fair result.
Patients with a Type-IV fracture had a greater magnitude of flexion
contracture (p = 0.04), reduced terminal flexion (p = 0.02), and a reduced net
ulnohumeral arc (p = 0.01). An ipsilateral radial head fracture did not appear
to affect ulnohumeral motion or the functional outcome.
CONCLUSIONS: Despite the presence of greater flexion contractures at
the time of follow-up in elbows with Type-IV fractures or fractures with an
ipsilateral radial head fracture, good to excellent outcomes with functional
ulnohumeral motion can be achieved following internal fixation of these
complex fractures. Type-IV injuries may be more common than previously
thought; such fractures often are associated with metaphyseal comminution or a
radial head fracture and may require supplemental fixation.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.