Capitellum Fractures

Topic updated on 02/15/16 4:31pm
  • Coronal fracture of the distal humerus at capitellum
  • Epidemiology 
    • 1% of elbow fractures
  • Mechanism of injury
    • fall on outstretched hand
  • Prognosis
    • most patients will gain functional range of motion but have residual stiffness
    • surgical treatment results are generally favorable
      • reoperation rates as high as 48%
 Bryan and Morrey Classification (with McKee modification)  
Type I Large osseous piece of the capitellum involved
Can involve trochlea 
Type II Kocher-Lorenz fracture
Shear fracture of articular cartilage
Articular cartilage separation with very little subchondral bone attached
Type III Broberg-Morrey fracture
Severely comminuted
Type IV McKee modification
Coronal shear fracture that includes the capitellum and trochlea

  • History
    • fall on outstretched arm
  • Symptoms
    • elbow pain
    • swelling 
  • Physical exam
    • may have mechanical block to flexion and extension
  • Radiographs
    • recommended
      • AP and lateral of the elbow
        • best demonstrated on lateral radiograph
  • CT
    • delineates fracture anatomy and classification  
  • Nonoperative
    • posterior splint immobilization for < 3 weeks
      • indications
        • nondisplaced Type I and Type II fractures (<2 mm displacement)
  • Operative
    • open reduction and internal fixation
      • indications
        • displaced Type I fractures (>2mm) 
        • Type IV fractures 
    • fragment excision
      • indications
        • displaced (>2mm) Type II fractures
        • displaced (>2mm) Type III fractures
    • total elbow arthroplasty
      • indications
        • unreconstructable capitellar fractures in elderly patients with associated medial column instability
  • ORIF
    • approach
      • lateral approach recommended for Type IV fx 
      • posterior approach can be used if associated with other elbow injuries
    • screw fixation 
      • headless screw fixation
      • minifragment screw using posterior to anterior fixation
        • counter sink screw using anterior to posterior fixation
    • avoid disruption of the blood supply that comes from the posterolateral aspect of the elbow 
  • Elbow contracture (most common) 
  • Nonunion (1-11% with ORIF)
  • Ulnar nerve injury
  • Heterotopic ossification (4% with ORIF)
  • AVN of capitellum
  • Nonunion of olecranon osteotomy


Please Rate Educational Value!
Average 3.0 of 28 Ratings

Qbank (4 Questions)

(OBQ12.195) An 88-year-old female presents after a fall onto her left arm. She reports isolated left elbow pain, and radiographs are shown in Figure A. She lives in an assisted living facility, and reports no other major medical problems. The best outcome can be expected with which of the following definitive treatment options? Topic Review Topic
FIGURES: A          

1. Open reduction internal fixation of the distal humerus fracture
2. Nonsurgical management with early passive range of motion exercises
3. Initial nonsurgical management followed by interpositional arthroplasty when the fracture has healed
4. Total elbow arthroplasty
5. Excision of the capitellar fragments and fixation of the trochlear fragments

(OBQ05.201) A 20-year-old man falls from his bicycle. He is going to be scheduled for open reduction internal fixation. What best describes the injury shown in Figure A and B? Topic Review Topic
FIGURES: A   B        

1. Coronoid fracture
2. Capitellum fracture with extension into the trochlea
3. Radial head and capitellum fracture
4. Isolated capitellum fracture
5. Trochlea fracture

Sorry, this question is available to Virtual Curriculum members only.

Click HERE to learn more and purchase the Virtual Curriculum today!

This is a Never-Been-Seen Question that can only be seen in Milestone Exams
for Virtual Curriculum members.

Click HERE to learn more and purchase the Virtual Curriculum today!

HPI - fall from bike
poll valuable suggestion regarding approaches for fixing coronal shear fractures...
92 responses
HPI - history of fall on semiflexed elbow
poll what does literature says about lateral v/s anterolateral approach for fixa...
70 responses
HPI - undiagnosed capitellum fracture 7 months ago. Excision of the capitellum fragme...
poll what is the best treatment?
217 responses codo.jpg codo.jpg
HPI - Fell 3 months ago. No dislocation.
poll What is the best treatment
147 responses
See More Cases



Topic Comments