gms | German Medical Science

Objectives/Interrogation: Treatment for the sequelae of capitellum fractures is not commonly described in the literature. Anconeus interposition arthroplasty has been described as a technique to treat radiocapitellar arthritis as well as joint replacement.

We present a unique case of a capitellum reconstruction with a vascularized ossseus graft from the second metatarsal bone.

Methods: A woman of 53 years old fell down and presented a capitellum fracture that was fixed with two cannulated screws, after 6 months the radiograph showed signs of necrosis of the capitellum, the patient was disabled and a surgery was offered. We reconstructed her capitellum by means of a vascularized osteochondral flap from the second metatarsal bone, and end-to-side anastomosis to the radial artery was performed and two cannulated screws were used to fix the graft to the humeral lateral column. The patient required 2 operations after the reconstruction, one because of diastasis of the olecranon osteotomy, the second because of a superficial infection which was solved with local debridement and oral antibiotic.

Results and Conclusions: After one year the range of movement is -30º-110º with complete pronosupination, and no pain (Figure 1 [Fig. 1], Figure 2 [Fig. 2]).

Anconeus interposition arthroplasty and joint replacement have been described as palliative methods fortreating the radiocapitellar arthritis, however the new treatment we describe is based on microsurgery techniques and provides a more anatomical solution to this severe problem in a young, active patient.