Adolescent Coronal Shear Fractures of the Distal Humerus: Surgical Approach and Outcomes.

Abstract

Purpose: Isolated coronal shear fractures of the distal humerus in adolescents are rare injuries with unique surgical challenges. Respect for the posterior blood supply, open physes, and need for direct visualization to achieve anatomic reduction are critical considerations in surgical fixation. This study presents a case series and a surgical approach used in treating these patients.

Methods: A retrospective review of patients aged 10-19 presenting to a single quaternary-care academic center from 2016 to 2023 with isolated capitellar and trochlear shear fractures was performed. Demographic data, injury mechanism, fracture classification, and surgical approach were recorded. Outcomes included elbow range of motion at the final follow-up, visual analogue scale pain scores, pediatric Patient-Reported Outcome Measurement Information System (PROMIS) scales, radiographic and clinical union, return to sport, and postoperative complications.

Results: Eight patients were included, four of whom were treated through a single-incision anterolateral approach. Average age was 13 years. Average time of the final clinical follow-up was 21 months, with a radiographic follow-up of 11 months. Five fractures were classified as Dubberly type 2A, two as type 3A, and one as type 3B. At the final follow-up, average elbow range of motion and visual analogue scale pain scores were 3-137 degrees and 0.28 (range: 0-2), respectively. PROMIS scores demonstrated an average mobility score of 55 (SD: 8), pain interference of 35 (SD: 5), and pediatric upper-extremity score of 55 (SD: 4). One patient with sickle cell disease developed avascular necrosis of the capitellum. There were no other postoperative complications.

Conclusions: Short-term clinical outcomes reveal low pain scores, near normal elbow motion, radiographic and clinical union, and normal patient-reported outcome measures in operatively treated coronal shear fractures of the distal humerus in adolescent patients. A single-incision anterolateral approach offers visualization of the anterior articular surface while respecting posterior soft tissues and the olecranon apophysis.

Type of study/level of evidence: Therapeutic V, case series.