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. 2024 Jul 3;25(1):514.
doi: 10.1186/s12891-024-07628-2.

Minimum four-year clinical outcomes after on-table reconstruction technique for Dubberley type III in coronal shear fractures of the capitellum and trochlea: a report of 10 patients

Il-Hyun Koh #  1 , Jung Jun Hong #  2 , Ho-Jung Kang  3 , Yun-Rak Choi  1 , Ji-Sup Kim  4   5
Affiliations

Minimum four-year clinical outcomes after on-table reconstruction technique for Dubberley type III in coronal shear fractures of the capitellum and trochlea: a report of 10 patients

Il-Hyun Koh et al. BMC Musculoskelet Disord. .

Abstract

Purpose: Comminuted coronal shear fractures of the distal humerus represent rare injuries and are difficult to treat, especially comminuted capitellum and trochlear fractures (Dubberley Type III). The on-table reconstruction technique of comminuted articular fractures may be an option, although it has not been reported in the coronal shear fracture of the distal humerus. The aim of the present case series is to determine the functional and radiological outcomes of on-table reconstructed Dubberley III fractures.

Methods: A retrospective review was conducted of 10 patients with Dubberley type III fractures in coronal shear fractures of the capitellum and trochlea who underwent an 'on-table' reconstruction technique between January 2009 and October 2019. All patients were evaluated using the disabilities of the arm, shoulder, and hand (DASH) score, American Shoulder and Elbow Surgeons(ASES) score, Mayo Elbow Score Performance Index (MEPI) score and at least 4 years later.

Results: All cases achieved union. At the final follow-up, the mean range of elbow motion was 11.5°of flexion contracture and 131.9° of further flexion. The mean DASH score was 21.2 (5.7) points (range 13.3-32.5). The mean ASES score was 88.6 ± 7.4 (range, 77 to 100). The mean MEPI score was 87 (10) points (range 70-100). In complication, partial osteonecrosis of capitellum is developed in one patient. One patient had heterotopic ossification without functional impairment.

Conclusion: The on-table reconstruction technique can be a reliable option in the surgical treatment of complex distal humerus fractures. This technique allows anatomical reduction of comminuted capitellum and trochlea, with a low risk of avascular necrosis over 4 years of follow-up.

Level of evidence: Level IV, retrospective case series.

Keywords: Capitellum; Coronal shear fracture; On-table reconstruction; Trochlea.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(A) Preoperative x-ray and CT scans of Dubberley type IIIA fracture. (B) ‘on-table’ reconstruction using subchondral K-wires. (C) postoperative x-ray and CT scan showing union after 1 year
Fig. 2
Fig. 2
(A) x-ray showing partial necrosis of capitellum at 3months postoperatively. (B) hardware removal and arthrolysis at 1 year postoperatively
See this image and copyright information in PMC

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