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. 2024 May;48(5):1295-1302.
doi: 10.1007/s00264-024-06151-2. Epub 2024 Mar 19.

Outcome determinants for coronal shear fractures of the distal humerus

Vasudeva Nagashree  1 , Jayaramaraju Dheenadhayalan  2 , Velmurugesan Purnaganapathi Sundaram  1 , Mohammed Zackariya  1 , S P Sivakumar  1 , Kavinkumar Vembanan  1 , Shanmuganathan Rajasekaran  1
Affiliations

Outcome determinants for coronal shear fractures of the distal humerus

Vasudeva Nagashree et al. Int Orthop. 2024 May.

Abstract

Purpose: Coronal shear fractures of the distal humerus involving the capitellum and trochlea are rare injuries. Internal fixation with headless compression screws provides a stable construct facilitating early mobilisation. Our study aimed to identify the key determinants of both radiological and functional outcomes of patients with distal humerus coronal shear fractures treated with internal fixation.

Methods: A retrospective analysis of 61 patients with distal humerus coronal shear fractures who were treated surgically was done. Demographics, fracture morphology, time to surgery, operative details such as surgical approach and implant used, quality of reduction, time to union, and associated complications from hospital records. Radiological outcomes were assessed using plain radiographs, and the functional outcomes were by Oxford Elbow Score (OES) and Mayo Elbow Performance Index (MEPI).

Results: Patients with anatomical reduction of the fracture had better functional outcomes and range of motion. The presence of posterior comminution of capitellum resulted in poorer outcomes (p = 0.03). Delayed presentation did not alter the outcome when the anatomical reduction was achieved. Myositis ossificans was noted in nine patients and non-union in five patients. Two patients developed avascular necrosis of the capitellum and arthritis of the elbow joint.

Conclusion: Anatomical reduction and posterior comminution are the two key determinants of the functional outcome in these coronal shear fractures of the distal humerus. Early mobilisation following a stable fixation is crucial in achieving a good outcome.

Keywords: Capitello-trochlear fractures; Coronal fracture; Headless compression screws; Mayo Elbow Performance Index (MEPI).

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