Functional outcome following internal fixation of rare type IV capitellum fractures using varied fixation methods: A case series

Abstract

Background: Capitellum fractures are very rare injuries, accounting for less than 1% of elbow fractures. These fractures are difficult to interpret on a plain radiograph and usually require a computed tomography scan to understand the complexity of the fracture. Treatment of such fractures vary from conservative treatment in the form of closed reduction and immobilization, excision of the fragment to open reduction and internal fixation with K wires, partially threaded 4mm cancellous screws or Herbert screws. In this paper we present the outcome of four cases of Type IV capitellum fractures that were managed operatively by different methods. Materials & Methods: Four patients were treated in our hospital from 2018 to 2019, for Type IV capitellum fractures. The mechanism of injury was a fall on the out stretched hand in three patients while the fourth patient was involved in a motor cycle accident. The fractures were equally distributed on either elbows, two on each side. The three males patients were aged between 18 to 30 years while the lone female was 40 years of age. All patients were operated in the supine position under general anaesthesia, using a tourniquet and with fluoroscopic guidance. Surgery was performed through an extended lateral Kocher’s approach. Definitive fixation in two patients was by using 2.7mm Herbert screws alone while in one with a lateral condyle humerus fracture, fixation was supplemented using plate and screws. K-wire fixation was used for one patient. Results: 2 patient attained a score of excellent in the Mayo Elbow Performance Score evaluation while 1 patient each had a good and a fair score. There was no evidence of arthritis, avascular necrosis or heterotopic ossification till 1 year of follow-up. Conclusion: Flawless reduction and fixation of the fragment with appropriate postoperative rehabilitation protocol are crucial to achieving optimal results.