Treatment of Capitellum and Trochlea Fractures Using Headless Compression Screws and a Combination of Dorsolateral Locking Plates

Shiro Yoshida; Kensuke Sakai; Kenjiro Nakama; Mitsuhiro Matsuura; Shingo Okazaki; Kotaro Jimbo; Masahiro Shirahama; Naoto Shiba

doi:10.7759/cureus.13740

Treatment of Capitellum and Trochlea Fractures Using Headless Compression Screws and a Combination of Dorsolateral Locking Plates

Cureus. 2021 Mar 6;13(3):e13740. doi: 10.7759/cureus.13740.

Authors

Shiro Yoshida^{1

2}, Kensuke Sakai², Kenjiro Nakama¹, Mitsuhiro Matsuura¹, Shingo Okazaki¹, Kotaro Jimbo², Masahiro Shirahama¹, Naoto Shiba¹

Affiliations

¹ Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, JPN.
² Department of Orthopedic Surgery, St. Mary's Hospital, Kurume, JPN.

Abstract

Introduction This study aimed to evaluate the clinical outcomes of 16 patients with capitellum and trochlea fractures that were treated using isolated headless compression screws or a combination of dorsolateral locking plates and anterior-to-posterior screws. We also investigated the presence of lateral epicondyle fragments because this fragment is especially important when making decisions regarding the surgical approach and implants. Materials and methods We conducted a retrospective analysis of 16 patients with capitellum and trochlea fractures. Clinical, radiographic (based on CT scans), and elbow-specific outcomes, including the Mayo Elbow Performance Index (MEPI), were evaluated at a mean of 23.5 months postoperatively. Results The average MEPI scores in patients with Dubberley type A (non-posterior comminution) and type B (posterior comminution) fractures were 88 and 78, respectively (p=0.08). Headless compression screws were used in 10 cases of type A fracture and one case of type B fracture. A combination of dorsolateral locking plates and anterior-to-posterior screws was used in five cases of type B fracture. Hardware loosening was seen in one case of type B fracture with isolated screw fixation. The presence of a lateral epicondyle fragment was significantly associated with the type B group (6/6 patients; 100%). In contrast, patients in the type A group rarely had posterior comminution of the lateral epicondyle fragment (2/10 patients; 20%). Conclusions Capitellum and trochlea fractures with posterior comminution, which typically presented with lateral epicondylar fragments, were safely and effectively treated with a combination of dorsolateral locking plates and anterior-to-posterior screws through lateral approaches. Cases without posterior comminution were treated with headless compression screws with no complications. The Dubberley classification system provides helpful information to determine the fixation strategy.

Keywords: capitellum and trochlea fracture; coronal shear fracture; distal humerus; dubberley; lateral epicondyle fragment; posterior comminution.