OUTCOME AFTER O RIF OF CAPITELLUM AND TROCHLEA FRACTURES

Abstract

The functional outcomes of twenty-eight patients with capitellum and trochlea fractures treated with open reduction and internal fixation were evaluated at a mean follow-up of fifty-five ± thirty-three months. Patients were independently evaluated by a series of questionnaires, radiographs, physical examination and strength testing. Patients with simple fractures did better than those with complicated fractures. The average DASH score was 19/100 and the average ROM was 20 – 130°. Two fractures did not unite and required conversion to total elbow arthroplasty.

A classification system is proposed based on fracture patterns, surgical technique and clinical outcomes.

Capitellum and trochlea fractures are uncommon fractures of the distal humerus. There is limited information about the functional outcome of patients managed with open reduction and internal fixation.

The functional outcome of twenty-eight patients (average age: forty-three ± thirteen years [range, twenty – seventy-one]) who were treated with open reduction and internal fixation for capitellum and trochlea fractures was evaluated at a mean follow-up of fifty-five ± thirty-three months (range, fourteen – one hundred and twenty-one). Patient outcomes were assessed by physical examination, radiographs, range of motion measurements, strength testing and self reported questionnaires (DASH, SF-36 ASES and PREE elbow scales).

There were eleven fractures involving the capitellum, four involving the capitellum and trochlea as one piece and thirteen in which the capitellum and trochlea were separate fragments. These fractures were further defined by the presence or absence of posterior comminution. Fourteen had isolated fractures and fourteen were associated with other elbow, forearm or wrist injuries. Patients with complicated fractures required more extensive surgery, had more complications resulting in secondary procedures and had poorer outcomes compared to those with simple fractures. The average DASH score (19/100), quality of life scores (SF-36: Physical=46, Mental=49) and the average ROM (20 – 130°) suggest favorable patient outcomes overall.

Patients with simple fractures had better results than those with more complicated fractures. A fracture classification system based on fracture patterns, surgical technique and clinical outcomes is proposed.