Coronal shear fractures of the distal humerus managed according to the Modified Dubberley Classification System

Sophie Shergold; Mina Derias; Robert Moverley; Richard J Murphy; Enis Guryel; Joideep Phadnis

doi:10.1016/j.jse.2021.07.002

Coronal shear fractures of the distal humerus managed according to the Modified Dubberley Classification System

J Shoulder Elbow Surg. 2022 Jan;31(1):133-142. doi: 10.1016/j.jse.2021.07.002. Epub 2021 Aug 11.

Authors

Sophie Shergold¹, Mina Derias², Robert Moverley³, Richard J Murphy⁴, Enis Guryel², Joideep Phadnis⁵

Affiliations

¹ Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
² University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK.
³ University Hospitals Dorset NHS Foundation Trust, Poole Hospital, Poole, Dorset, UK.
⁴ University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK. Electronic address: richardjamesmurphy@icloud.com.
⁵ Brighton and Sussex Medical School, University of Sussex, Brighton, UK; University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK.

PMID: 34390839
DOI: 10.1016/j.jse.2021.07.002

Abstract

Background: Coronal shear fractures of the capitellum and trochlea are relatively uncommon and can be challenging to treat because of variable articular comminution and poor bone stock. Classification is valuable to help guide surgical decision making and prognosis. The aim of this study was to present a large series of coronal shear fractures treated according to the Modified Dubberley Classification System (MDCS).

Methods: Forty-five patients with a coronal shear fracture were followed up (12-93 months, mean: 28 months) after surgical intervention. Fractures were classified according to the MDCS by 3 observers, and outcome data collected included Oxford elbow score (OES), visual analog pain score (VAS), range of motion, complications, and radiographic findings.

Results: There were 10 type 1, 12 type 2, 8 type 3, and 15 type 4 fractures. There were 26 subtype B fractures (posterior comminution). A total of 37 patients underwent open reduction and internal fixation (ORIF) and 8 primary arthroplasty. The median OES and VAS were 43(16-48) and 2 (0-9), respectively. Median flexion extension arc was 125° (range, 70°-140°). There was no significant difference in OES, VAS, or range of motion according to fracture type (types 1-4), subtype (type a or b), or treatment method (arthroplasty vs. ORIF). The overall complication and reoperation rates were 31% and 33%, respectively. A total of 75% of complications occurred in type 3 and 4 fractures, and there was a nonsignificant trend toward higher complication rate in type B fractures than type A fractures (34% vs. 16%, P = .19). Patients with a type B fracture who underwent screw-only fixation had a significantly lower OES and higher complication rate compared with when they had combined plating with screws (OES, P = .03; complications P = .04) and compared with when an arthroplasty was performed (OES, P = .05; complications P = .04).

Conclusion: Consistently good outcomes can be achieved by classification and management according to the MDCS. It is recommended that type B fractures undergo combined plate and screw fixation and that type 4 fractures should be considered for arthroplasty because of the higher risk of complications with ORIF.

Keywords: Coronal shear fracture; distal humerus; elbow; modified Dubberley classification.

MeSH terms

Bone Plates
Elbow Joint* / diagnostic imaging
Elbow Joint* / surgery
Fracture Fixation, Internal
Humans
Humeral Fractures* / diagnostic imaging
Humeral Fractures* / surgery
Humerus
Range of Motion, Articular
Retrospective Studies
Treatment Outcome