Management and clinical outcomes of Dubberley type A capitellar fractures

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-17 DOI:10.1016/j.jcot.2025.102926

Prateek A. Saxena , Abhinandan Kotian , Faris Ali , Tamara Mertz , Andrew P. Dekker , Neil Ashwood

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引用次数: 0

Abstract

Aims

Capitellar fractures are uncommon, accounting for 0.5–1 % of all elbow fractures. These fractures are best managed surgically to restore articular congruity. Dubberley type A fractures treated with anterolateral or lateral surgical approaches have been associated with high complication rates. The ‘Global’ approach to elbow has been conceptualised in order to comprehensively approach elbow injuries. The aim of this study was to evaluate the clinical outcomes of fractures of the capitellum treated using global surgical approach.

Methods

Data was prospectively collected for all patients presenting between 1998 and 2020.Patient's demographics, mechanism of injury, Mayo Elbow Performance Index MEPI, Grip Strength and radiographs were retrospectively collected and analysed.

Results

31 patients met the inclusion criteria with a mean age of 47yrs (IQR 12–81yrs) years, 18 males: 13 female patients. According to Dubberley classification, 24 were type I, 5 were type II and 2 were type III. 4 patients sustained associated collateral ligament injuries and 2 patients had radial head fractures. Global approach with an inside Kaplan approach was used in 26 patients, others were treated with an inside Kocher or anterior approaches. Almost all fractures were fixed using headless screws alone (n = 25),6 patients had fixation augmented with bioabsorbable rods or a posterior buttress plate. Mean follow up was 46 months. Mean MEPI was 89 (SD8), Extension 9.35 ± 5.32, Flexion 130.29 ± 8.7, Pronation 59.16 ± 7.034, Supination 63.97 ± 7.1. Mean Grip strength was 22.94 ± 4.5. These were significantly better following surgery (p < 0.001). Further surgery was only required in 1 case for stiffness. Overall complication rate was 9.6 %. There were no infections or cases of instability following fixation.

Conclusion

This study is one of the largest case series reporting good functional outcomes in Dubberley type A fractures treated with headless screws using global surgical approach. We report lowest complication rate,100 % fracture union rate and good MEPI scores.

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Dubberley A型小头骨折的治疗及临床结果

肱骨骨折并不常见，占所有肘关节骨折的0.5 - 1%。这些骨折最好通过外科手术来恢复关节的一致性。采用前外侧或外侧手术入路治疗Dubberley A型骨折具有较高的并发症发生率。为了全面处理肘部损伤，“全球”肘部方法已被概念化。本研究的目的是评估采用整体手术入路治疗肱骨小头骨折的临床结果。方法前瞻性收集1998年至2020年期间就诊的所有患者的数据。回顾性收集和分析患者的人口统计学资料、损伤机制、梅奥肘关节运动指数、握力和x线片。结果31例患者符合纳入标准，平均年龄47岁（IQR 12 - 81岁），男性18例，女性13例。根据Dubberley分类，I型24例，II型5例，III型2例。4例伴发副韧带损伤，2例桡骨头骨折。26例患者采用内Kaplan入路，其余患者采用内Kocher入路或前路入路。几乎所有骨折均单独使用无头螺钉固定（n = 25），6例患者使用生物可吸收棒或后路支撑板加强固定。平均随访时间为46个月。平均MEPI为89 (SD8)，伸直9.35±5.32，屈曲130.29±8.7，旋前59.16±7.034，旋后63.97±7.1。平均握力为22.94±4.5。手术后明显好转(p <；0.001)。仅1例因僵硬需要进一步手术。总并发症发生率为9.6%。无感染或固定后不稳定病例。结论：本研究是报道采用整体手术入路无头螺钉治疗Dubberley A型骨折功能良好的最大病例系列之一。我们报告了最低的并发症发生率，100%的骨折愈合率和良好的MEPI评分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.