Our Recent Experience in Management of Capitellum and Capitellum-Trochlea Shear Injuries in Skeletally Immature Patients

Common opinion is that capitellum and capitellum-trochlea shear injury almost exclusively observed in adults. During last 2 years we treated 10 skeletally immature patients with this type of injury, five boys and three girls with age range from 12 to 15 years. Eight of them were available for follow-up.

All children sustained low energy trauma. Isolated fractures of capitellum encountered in five and capitellum-trochlea shear injures in three children. All of capitellum-trochlea shear injures were comminuted. The patients were treated surgically.

The features of these injuries, pitfalls of treatment and complications were summarized.

Associate injures included radial head, medial and lateral epicondyles fractures, elbow dislocation. No neurovascular damage was observed on initial presentation.

The complications we faced with were: early surgical site infection -1case, reserved after oral short course of antibiotics, temporary posterior interosseous nerve palsy, reserved in one week -1, avascular necrosis of capitellum -1 and elbow stiffness seen in 2 cases.

We can conclude that these types of injury prone to be underestimated on initial evaluation, but since correct diagnosis is made, the patients can be successfully surgically treated. Isolated fractures of capitellum can be addressed through lateral approach and capitellum-trochlear comminuted fracture is best managed through posterior approach with olecranon osteotomy. The most appropriate fixation was achieved by headless compressive screws or absorbable nails. Adequate visualization can be obtained with minimal soft tissue stripping and preservation of collateral ligaments. Stable fixation permits early range of motions exercise and long standing stiffness prevention.

The pediatric orthopedic surgeon has to be familiar with this type of injuries as it seems to be much more common than previously considered.