Choice of surgical approach for capitellar fractures based on pathoanatomy of fractures: outcomes of surgical management.

The understanding of the anatomic configuration of the fractures of the capitellum has enhanced in the last few years, and the classification of these fractures continues to evolve. It is essential to tailor the surgical approaches to these fractures based on the state-of-the-art classifications. Thirty-three patients with fractures of the capitellum were included in this retrospective study. The mean age of the patients was 37.9 years, and the mean follow-up period was 24.6 months. Seventeen patients had Bryan-Morrey type I fracture, three had type II fracture, two had type III fracture and eleven had type IV fracture. Of the 11 patients with Bryan-Morrey type 4 fracture, 5 patients belonged to Dubberley 2A and 3A category and 6 patients belonged to Dubberley 2B and 3B category. Bryan-Morrey type 1, 2 and 3 fractures were approached via extended lateral approach. Bryan-Morrey type 4 was further classified using the Dubberley classification. Dubberley 2A and 3A fractures were approached via the anterolateral approach, and Dubberley 2B and 3B fractures were approached via the posterior transolecranon approach. Fracture united in all patients. Three patients showed slight delay in union, but union was achieved eventually. Two patients had avascular necrosis of the capitellar fragment. The mean range of flexion/extension was 133° (SD ± 8.0°), and pronation/supination was 151° (SD ± 6.7°). The mean Mayo Elbow Performance Index at final follow-up was 80.9 (SD ± 13.9). Based on the MEPI score, 14 patients had excellent, 10 patients had good, 6 patients had fair and 3 patients had poor results (Dubberley type 3B fractures). Correct choice of surgical approach facilitates the accuracy of reduction and fixation of these difficult fractures. It also helps to minimize the requirement of two-incision approach. Anterolateral approach is an excellent approach for Dubberley 2A and 3A fractures. LEVEL OF EVIDENCE: Level IV.

Single locking compression plate fixation of extra-articular distal humeral fractures.

BACKGROUND: Earlier literature on fixation of distal third humeral fractures describes the use of elaborate modification of existing implants, custom-made implants and dual plating. These modifications have the disadvantages of limitations of hardware availability and cost as well as longer surgical exposure to accommodate the plates. The aim of this study was to assess the effectiveness of osteosynthesis of extra-articular diaphyseal fractures of the distal third of the humerus using a single 4.5-mm locking compression plate (LCP) with two-screw purchase in the distal fragment. MATERIALS AND METHODS: We performed internal fixation of distal third extra-articular humeral fractures in 22 adult patients using 2-3 lag screws neutralized with a single 4.5-mm locking compression plate with only two screws in the distal fragment. The mean follow-up period was approximately 1.6 years. RESULTS: Fractures united in all 22 patients with minimal complications. The mean time to union of fracture was 13 weeks. The Mayo elbow score and the DASH scores were in the excellent and good category in all patients at final follow-up. CONCLUSIONS: Our study showed that it is possible to obtain excellent outcomes in distal third fractures using only a single 4.5-mm LCP with two-screw (4-cortices) purchase in the distal fragment. The disadvantages inherent in the previous methods can be avoided with the use of the present technique. This technique obviates the need for the use of customized distal humeral implants and modified implants in most patients. LEVEL OF EVIDENCE: Level IV.