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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Surgical Dislocation and Cancellous Bone Graft is Alternative Operative Treatment in Capitellar and Trochlea Fracture with Elbow Instability

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  • presenting/speaker Young Ho Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Min Ho Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Yo Han Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Yeun Soo Kim - Seoul National University College of Medicine, Seoul, South Korea
  • Che Ho Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Young Ju Chae - Seoul National University College of Medicine, Seoul, South Korea
  • Qingyuan Li - Seoul National University College of Medicine, Seoul, South Korea
  • Goo Hyun Baek - Seoul National University College of Medicine, Seoul, South Korea

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1255

doi: 10.3205/19ifssh1421, urn:nbn:de:0183-19ifssh14210

Published: February 6, 2020

© 2020 Lee et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Recently, AO classification using fracture location, degree of articular involvement and type of fracture in distal humerus fracture is widely used and is helping to standardize the treatment results, and determine the treatment method and prognosis. However, fractures involving the capitellum and trochlea are rare and often not consistent with the AO classification or the previously reported classification. In addition, the treatment is still very controversial. Therefore, in this study, we propose a surgical treatment method for elbow instability with capitellum and trochlea fracture.

Methods: Fifteen patients with elbow instability with capitellum and trochlea fracture were treated surgically between 2003 and 2014. The lateral approach was used, and fracture site of the capitellum and trochlea was completely exposed by the medial dislocation of the elbow. The articular bony fragment was anatomically reduced and fixed with absorbable pins and screws. Iliac bone graft was applied to the bony defect. The mean age at operation was 53 years (range, 16 to 76 years), and the mean follow-up period was 24 months (range, 18 to 71 months). Postoperatively, ROM(range of motion) was measured, and Mayo Elbow Performance Index (MEPI) and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was assessed.

Results and Conclusions: The range of motion of the elbow at final follow-up was 142.5 degrees (SD = 7.9) in flexion/extension and 162.5 degrees (SD = 8.8) in supination/pronation. The mean MEPI was 90.5 (SD = 7.6), and MEPI stability score was 9.5 out of 10 (SD = 1.5). The mean DASH score was 11.2 (SD = 11.9). One patient had evidence of osteonecrosis, but she had no complaints of pain and adequate ROM at last follow-up.

In elbow instability patients with capitellum and trochlea fracture, we were able to effectively expose the fractured site by lateral approach using medial dislocation of the elbow, without the olecranon osteotomy. In addition, anatomical reduction and stable internal fixation were achieved by disimpaction, autologous iliac bone graft, absorbable pin and screw fixation, and results were good. Therefore, the method proposed in this study may be a good alternative for the surgical treatment of elbow instability patients with capitellum and trochlea fracture.