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J Am Acad Orthop Surg, Vol 16, No 12, December 2008, 716-728.
© 2008 the American Academy of Orthopaedic Surgeons
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Coronal Plane Partial Articular Fractures of the Distal Humerus: Current Concepts in Management

David E. Ruchelsman, MD, Nirmal C. Tejwani, MD, Young W. Kwon, MD, PhD and Kenneth A. Egol, MD

Dr. Ruchelsman is Chief Resident, Department of Orthopaedic Surgery, NYU–Hospital for Joint Diseases, New York, NY. Dr. Tejwani is Associate Professor, Department of Orthopaedic Surgery, NYU–Hospital for Joint Diseases. Dr. Kwon is Assistant Professor, Department of Orthopaedic Surgery, NYU–Hospital for Joint Diseases. Dr. Egol is Associate Professor, Department of Orthopaedic Surgery, NYU–Hospital for Joint Diseases.

Reprint requests: Dr. Egol, Department of Orthopaedic Surgery NYU–Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003.

Dr. Tejwani or a member of his immediate family has participated in a speakers bureau or given paid presentations for Biomet, Stryker, and Zimmer and has received research or institutional support from Biomet. Dr. Kwon or a member of his immediate family is a paid consultant to Exactech and Smith & Nephew. Dr. Egol or a member of his immediate family has participated in a speakers bureau or given paid presentations for Biomet; is an unpaid consultant for Exactech; has received research or institutional support from Biomet, Smith & Nephew, Stryker, and Synthes; and holds stock or stock options in Johnson & Johnson. Neither Dr. Ruchelsman nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Partial articular fractures of the distal humerus commonly involve the capitellum and may extend medially to involve the trochlea. As the complex nature of capitellar fractures has become better appreciated, treatment options have evolved from closed reduction and immobilization and fragment excision to a preference for open reduction and internal fixation. The latter is now recommended to achieve stable anatomic reduction, restore articular congruity, and initiate early motion. More complex fracture patterns require extensile surgical exposures. The fractures are characterized by metaphyseal comminution of the lateral column and have associated ipsilateral radial head fracture. With advanced instrumentation, elbow arthroscopy may be used in the management of these articular fractures. Though limited to level IV evidence, clinical series reporting outcomes following open reduction and internal fixation of fractures of the capitellum, with or without associated injuries, have demonstrated good to excellent functional results in most patients when the injury is limited to the radiocapitellar compartment. Clinically significant osteonecrosis and heterotopic ossification are rare, but mild to moderate posttraumatic osteoarthrosis may be anticipated at midterm follow-up.






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Copyright © 2008 by the American Academy of Orthopaedic Surgeons.