Capitellum fracture: Difference between revisions
| Line 22: | Line 22: | ||
==Management== | ==Management== | ||
*[[Long arm posterior splint]] for Operative / Non operative | *[[Long arm posterior splint]] for Operative / Non operative | ||
* Indications for non operative management | * Indications for non-operative management | ||
** Less than 2mm of displacement | ** Less than 2mm of displacement | ||
* Indications for operative management | * Indications for operative management | ||
Revision as of 04:26, 13 June 2016
Background
- Fracture of distal humerus at capitellum
- Rare, occurs in approx 1% of elbow fractures
- Mechanism: FOOSH
- Often require surgery, with good prognosis
Clinical Features
- 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
Diagnosis
- 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
- Long arm posterior splint for Operative / Non operative
- Indications for non-operative management
- Less than 2mm of displacement
- Indications for operative management
- More than 2 mm of displacement
- Capitellum with co-existing trochlea involvement
- Comminuted fracture
Disposition
- Normally outpatient