Abstract
Introduction
A prospective study was done using Kirschner (K) wires to internally fix capitellum fractures and its results were analysed.
Materials/Methods
Since 1989, unstable displaced 17 capitellum fractures were anatomically reduced and internally fixed by inserting K wires in coronal plane from the capitellum into trochlea. The lateral end of wires were bent in form of a staple behind the fracture plane and anchored into the lateral humeral condyle with pre-drilled holes. Additional screws were used in 2 cases to stabilise the lateral pillar comminution. The capitellum was exposed with a limited modified lateral elbow approach between anconeus and extensor carpi ulnaris. The capsule was reflected anteriorly to expose the capitellum and trochlea. The deeper dissection was limited anterior to lateral collateral ligament (LCL) keeping it intact. The capitellum fragment was reposition under the radial head and anatomically reduced by full flexion of elbow and then internally fixed. Total 17 patients (7 males and 10 females) with average ages 34.8 years(14 to 75) had fractures, Type I: (Hans Steinthal #) 12, Type II: (Kocher Lorez #) 1, and Type III: (Broberg and Morrey #) 4. Post-operatively the patients were not given any immobilisation and were mobilised immediately.
Results
Patients were assessed clinically and radiologically. Average followup was 31.7 (18–35) months. Capitellum fractures healed in all the patients. Mayo elbow score was excellent in 12, good in 4, and fair in 1 patient. Average elbow ROM was 5 to 132 degrees, pronation 84.5 (79–90) degrees and supination 88 (85–91) degrees. Complications seen were wire pain in 4 patients, loosening of wires in 2 which required early removal. We did not see any infection, non-union or avascular necrosis in the time scale we studied.
Conclusions
We found a simple manoeuvre of hyper-flexion of elbow reduced the capitellum anatomically, and K wires stapling technique to be very easy and stable. A limited exposure of capitellum helped to restore immediate stable elbow with good function.
