Classifications and Treatment of Capitellum Fracture (Elbow Injury):
Capitellum is the anterior portion of the lateral humeral condyle. This fracture is unique in being intra-articular always.
Mechanism of injury
Fall on an outstretched hand, with flexion or extension of the elbow and the resulting shear forces through the radial head slices the capitellum.
Classifications
Based on the size of the articulating fragment, it is classified into three types:
- Type I (Hahn-Steinthal variety): This involves a large portion of the capitellum and a small chunk of trochlea with less of subchondral portion.
- Type II (Kocher-Lorenz variety): Here only a large portion of the capitellum is involved with a huge chunk of subchondral bone.
- Type III: Comminuted fracture.
Clinical Features
- The patient complains of pain and swelling over the lateral aspect of the elbow.
- Elbow and forearm movements are also restricted.
Radiographs
A true lateral view of the elbow is mandatory to accurately diagnose this fracture. The characteristic finding of this fracture is the presence of “double arc sign” described by McKay over the X-ray.
Treatment
- Undisplaced fractures can be managed conservatively by an above elbow plaster cast or slab for 3 to 4 weeks.
- Displaced fractures need open reduction and internal fixation with minifragment screws.
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