Capitellum fracture: Difference between revisions
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Revision as of 21:17, 23 July 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
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
- Long arm posterior splint for Operative / Non operative
Non-operative management
- Less than 2mm of displacement
Operative management
- More than 2 mm of displacement
- Capitellum with co-existing trochlea involvement
- Comminuted fracture
Disposition
- Normally outpatient, unless concerning neurovascular injury, open fracture, or coexisting injuries requiring admission
Potential Complications
- Elbow contracture
- Nonunion
- AVN
- Ulnar nerve injury
See Also
References
- Orthobullets