The Journal of Bone and Joint Surgery (American). 2006;88:46-54.
doi:10.2106/JBJS.D.02954
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Outcome After Open Reduction and Internal Fixation of Capitellar and Trochlear Fractures

James H. Dubberley, MD, FRCSC1, Kenneth J. Faber, MD, FRCSC2, Joy C. MacDermid, BScPT, PhD2, Stuart D. Patterson, MD, FRCSC3 and Graham J.W. King, MD, FRCSC2

1 University of Manitoba, Pan Am Clinic, 75 Poseidon Bay, Winnipeg, MB R3M 3E4, Canada. E-mail address: jdubberley{at}panamclinic.com
2 The Hand and Upper Limb Centre, St. Joseph's Health Centre, University of Western Ontario, 268 Grosvenor Street, London, ON N6A 4L6, Canada
3 Central Florida Orthopaedic Surgery Associates, 2000 East Edgewood Drive, Suite 112, Lakeland, FL 33803-3639

Investigation performed at the Hand and Upper Limb Centre, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Capitellar and trochlear fractures are uncommon fractures of the distal aspect of the humerus. There is limited information about the functional outcome of patients managed with open reduction and internal fixation.

Methods: The functional outcome of twenty-eight patients, with a mean age (and standard deviation) of 43 ± 13 years, who were treated with open reduction and internal fixation for capitellar and trochlear fractures was evaluated at a mean duration of follow-up of 56 ± 33 months. Patient outcomes were assessed with physical and radiographic examination, range-of-motion measurements, strength testing, and self-reported questionnaires (Short Form-36, Mayo Elbow Performance Index, American Shoulder and Elbow Surgeons Elbow Assessment Form, and Patient-Rated Elbow Evaluation scales).

Results: Eleven fractures involved the capitellum with or without fracture of the lateral ridge of the trochlea, four involved the capitellum and trochlea as one piece, and thirteen involved the capitellum and trochlea as separate fragments. These fractures were further characterized by the presence or absence of posterior comminution. Fourteen patients had isolated fractures, and fourteen had other elbow, forearm, or wrist injuries. Patients with more complex fractures required more extensive surgery, had more complications resulting in secondary procedures, and had poorer outcomes compared with those with simple fractures. The average score on the Mayo Elbow Performance Index (91 ± 11), the average quality-of-life scores (46 on the physical component and 50 on the mental component of the Short Form-36), and the average range of motion (19° to 138°) suggest favorable patient outcomes overall. Two comminuted fractures did not unite and required conversion to a total elbow arthroplasty.

Conclusions: Patients with isolated noncomminuted capitellar and/or trochlear fractures have better results than those with more complex fractures. A classification system based on the radiographic patterns of these fractures is recommended.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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