Capitellum fracture: Difference between revisions
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==Background== | ==Background== | ||
[[File:Capitulumhumeri.png|thumb|Capitellum of humerus.]] | |||
*Fracture of distal humerus at capitellum | *Fracture of distal humerus at capitellum | ||
*Rare, occurs in | *Rare, occurs in approximately 1% of elbow fractures | ||
*Often require surgery, with good prognosis | *Often require surgery, with good prognosis | ||
{{Proximal arm fracture DDX}} | |||
==Clinical Features== | ==Clinical Features== | ||
*Mechanism: FOOSH | |||
*Pain, swelling, may have block to flexion / extension | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Elbow DDX}} | {{Elbow DDX}} | ||
== | ==Evaluation== | ||
*[[Elbow X-ray]] | |||
**Fractures are often subtle | |||
**Best seen on lateral XR | |||
***Look for abnormal fat pad | |||
***Look for radiocapitellar line disruption | |||
****If possible, lateral elbow is shot at 45 degrees to pick up subtle fractures | |||
*Consider CT to further identify fracture / operative planning | |||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Immobilization=== | |||
*[[Long arm posterior splint]] for Operative / Non operative | |||
==Disposition== | ==Disposition== | ||
*Normally outpatient | *Normally outpatient, unless concerning neurovascular injury, [[open fracture]], or coexisting injuries requiring admission | ||
===Specialty Outpatient Care=== | |||
====Non-operative management==== | |||
*Less than 2mm of displacement | |||
====Operative management==== | |||
*More than 2 mm of displacement | |||
*Capitellum with co-existing trochlea involvement | |||
*Comminuted fracture | |||
==Potential Complications== | |||
*Elbow contracture | |||
*Nonunion | |||
*AVN | |||
*Ulnar nerve injury | |||
==See Also== | ==See Also== | ||
*[[Splinting: Humerus]] | |||
*[[Elbow diagnoses]] | *[[Elbow diagnoses]] | ||
*[[Elbow_Fracture_(Adult)|Elbow Fracture (Main)]] | *[[Elbow_Fracture_(Adult)|Elbow Fracture (Main)]] | ||
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==References== | ==References== | ||
*[http://www.orthobullets.com/trauma/1023/capitellum-fractures Orthobullets] | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Latest revision as of 21:58, 22 June 2020
Background
- Fracture of distal humerus at capitellum
- Rare, occurs in approximately 1% of elbow fractures
- Often require surgery, with good prognosis
Humerus Fracture Types
Clinical Features
- Mechanism: FOOSH
- Pain, swelling, may have block to flexion / extension
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
- Elbow X-ray
- Fractures are often subtle
- Best seen on lateral XR
- Look for abnormal fat pad
- Look for radiocapitellar line disruption
- If possible, lateral elbow is shot at 45 degrees to pick up subtle fractures
- Consider CT to further identify fracture / operative planning
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Immobilization
- Long arm posterior splint for Operative / Non operative
Disposition
- Normally outpatient, unless concerning neurovascular injury, open fracture, or coexisting injuries requiring admission
Specialty Outpatient Care
Non-operative management
- Less than 2mm of displacement
Operative management
- More than 2 mm of displacement
- Capitellum with co-existing trochlea involvement
- Comminuted fracture
Potential Complications
- Elbow contracture
- Nonunion
- AVN
- Ulnar nerve injury