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Open Reduction and Internal Fixation of Capitellar Fractures via Headless Screws

March 01, 2019

Contributors: Kenneth A Egol, MD; Sanjit R Konda, MD; Dylan Lowe, MD; Theodore S. Wolfson, BS; Theodore S. Wolfson, BS

Partial articular fractures of the distal humerus often involve the capitellum and may extend medially into the trochlea. With advancements in diagnostic imaging, the complexity of these fracture patterns has become better appreciated. Several classification systems are available to characterize these fractures and reliably direct management. As knowledge of capitellar fractures has improved, management has evolved from closed reduction, immobilization, and fragment excision to open reduction and internal fixation. Open reduction and internal fixation is currently the standard of care to achieve a stable anatomic reduction, restore articular congruity, and allow for early range of motion. Surgical approaches vary depending on the fracture pattern; however, extensile lateral approaches to the elbow are a mainstay for exposure. Fixation methods vary and are tailored to fracture pattern and morphology. Modern headless screw constructs allow for anatomic fixation of isolated capitellum fractures with minimal articular disruption. This video demonstrates open reduction and internal fixation of an isolated capitellum fracture via cannulated headless screws through a limited lateral approach. The video provides an overview of the anatomy, classification, diagnosis, and management of partial articular fractures of the lateral column of the distal humerus involving the capitellum. Surgical indications and considerations, including approach and fixation, are discussed. The video discusses the case presentation of a 63-year-old woman with an acute type I capitellar fracture. Open reduction and internal fixation was performed via a lateral approach with the use of headless compression screws. Anatomic articular reduction and stable fixation were achieved intraoperatively. Radiographic reduction was maintained, and fracture union was attained without complications. Capitellar fractures may involve various amounts of articular disruption and comminution. A high index of suspicion should be maintained for medial fracture extension and posterolateral comminution. Open reduction and internal fixation via a direct lateral approach remains a mainstay for the management of isolated capitellum fractures. Modern headless compression screw systems allow for anatomic articular reduction with stable, consistent fixation.