A Systematic Review of Surgical Techniques for the Repair of Capitellar Fractures

Abstract

The rarity of capitellum fractures makes them a thorny problem in orthopedic practice, as fracture reduction and repair to restore joint function within a complex elbow joint are difficult. Properly treated, these fractures can avoid complications such as stiffness, instability, and posttraumatic arthritis. Several surgical techniques optimize patient outcomes, including open reduction with internal fixation using Herbert screws, buttress plating, and headless compression screws (HCS). The choice of technique, however, is determined by many factors, including fracture type, patient characteristics, and surgeon preference. This systematic review compares the clinical and functional outcomes of surgical techniques for capitellar fracture repair. Factors influencing the selection of surgical approach are also reviewed, including fracture complexity, patient demographics, and bone quality. To perform a systematic literature search, we followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched the major databases, including PubMed, Cochrane Library, Embase, and Web of Science. Search terms included "capitellar fracture", "elbow fracture", and "surgical fixation techniques". Clinical or biomechanical outcomes of capitellar fracture fixation using different surgical techniques were included, including fixation stability, range of motion, healing rates, and complication rates. In detail, three foundational studies were analyzed in depth, with the use of Herbert screws, Kirschner wires, and buttress plating. Clinical trials suggest that Herbert screws enable earlier mobilization and improved functional outcomes, particularly in younger patients with Type I fractures. Biomechanical studies, such as those using HCS with buttress plating, indicate enhanced stability, especially in osteoporotic bone conditions. Factors such as patient age, bone quality, and fracture pattern appear to influence the choice of surgical technique. Herbert screws provide effective fixation and support early mobilization, making them suitable for stable fractures in healthier patients. However, in cases of osteoporotic or complex fractures, augmented techniques, such as buttress plating, may be more appropriate to improve stability and reduce the risk of fixation failure. The selection of surgical techniques for capitellar fractures should take into account patient-specific factors to optimize clinical outcomes, and this review emphasizes the need for a tailored approach in selecting surgical techniques for capitellar fractures.

Keywords: capitellum; fixation; fracture; outcome studies; patient outcomes; surgical approach.

Figure 1. The PRISMA flowchart representing the study selection process

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Image credit: This is an original image created by the author Manahil Awan