OPERATIVE TREATMENT OF Dubberley TYPE 3B CAPITULUM-TROCHLEA FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUXiaochuan ,  XIANGMing , YANGGuoyong , CHENHang , TANGHaochen

Department of Upper Extremity, Sichuan Orthopaedic Hospital, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

XIANGMing, Email: josceph_xm@sina.com

Keywords：

Elbow joint; Capitulum-trochlea fracture; Dubberley type 3B; Internal fixation

DOI：

10.7507/1002-1892.20140259

Video：

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Objective To investigate the method and effectiveness of operative treatment of Dubberley type 3B capitulum-trochlea fractures. Methods Between January 2009 and December 2012, 8 cases of Dubberley type 3B capitulum-trochlea fractures were treated. There were 2 males and 6 females with an average age of 55 years (range, 43-65 years). The injury was caused by falling in 6 cases, electric bicycle accident in 1 case, and traffic accident in 1 case. All fractures were fresh and closed injury. No neural or vascular injury was found. The time between injury and operation was 3-15 days (mean, 5.9days). Olecranon osteotomy was performed by a posterior midline skin incision of the elbow; 3.0 mm Herbert compression screws placed from posterior to anterior, 2.4 mm L shape locking compression plate designed for distal radius or 2.7 mm anatomical locking compression plate designed for distal humerus and 1.0 mm Kirschner wires or 3.0 mm Herbert screw for the transverse and coronal plane in the subchondral of anterior articular surface were used for fixation; and the lateral and medial collateral ligaments were repaired. Results All incisions healed by first intention. The patients were followed up 12-18 months (mean, 14.5 months). The X-ray films showed that fracture healing was achieved at 12-24 weeks (mean, 15 weeks) in 7 cases. Fracture nonunion and partial bone resorption in the capitellum were observed in 1 case. No failure of internal fixation, ulnohumeral joint instability, or traumatic arthritis occurred. At last follow-up, the range of motion of injured elbow was 0-40° in extension (mean 25.0°), 100-135° in flexion (mean, 116.3°), 60-70° in pronation (mean, 61.3°), and 80-90° in supination (mean, 81.3°). The elbow function score was 64-96 (mean, 81.1) according to the Broberg-Morrey evaluation criteria; the results were excellent in 2 cases, good in 4 cases, and fair in 2 cases with an excellent and good rate of 75%. The visual analogue scale (VAS) score was 0-3 (mean, 1). Conclusion For Dubberley type 3B capitulum-trochlea fractures, an early anatomic reconstruction of capitellar and trochlea, repair of the medial and lateral collateral ligament, and early active mobilization can obtain good functional results.

Citation： HUXiaochuan, XIANGMing, YANGGuoyong, CHENHang, TANGHaochen. OPERATIVE TREATMENT OF Dubberley TYPE 3B CAPITULUM-TROCHLEA FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1194-1198. doi: 10.7507/1002-1892.20140259 Copy

1.	Lee JJ, Lawton JN.Coronal shear fractures of the distal humerus.J Hand Surg (Am), 2012, 37(11):2412-2417.
2.	Dubberley JH, Faber KJ, Macdermid JC, et al.Outcome after open reduction and internal fixation of capitellar and trochlear fractures.J Bone Joint Surg (Am), 2006, 88(1):46-54.
3.	Guitton TG, Doornberg JN, Raaymakers EL, et al.Fractures of the capitellum and trochlea.J Bone Joint Surg (Am), 2009, 91(2):390-397.
4.	Brouwer KM, Jupiter JB, Ring D.Nonunion of operatively treated capitellum and trochlear fractures.J Hand Surg (Am), 2011, 36(5):804-807.
5.	Durakbasa MO, Gumussuyu G, Gungor M, et al.Distal humeral coronal plane fractures:management, complications and outcome.J Shoulder Elbow Surg, 2013, 22(4):560-566.
6.	Broberg MA, Morrey BF.Results of delayed excision of the radial head after fracture.J Bone Joint Surg (Am), 1986, 68(5):669-674.
7.	Watts AC, Morris A, Robinson CM.Fractures of the distal humeral articular surface.J Bone Joint Surg (Br), 2007, 89(4):510-515.
8.	Ring D, Jupiter JB, Gulotta L.Articular fractures of the distal part of the humerus.J Bone Joint Surg (Am), 2003, 85-A (2):232-238.
9.	Ruchelsman DE, Tejwani NC, Kwon YW, et al.Coronal plane partial articular fractures of the distal humerus:current concepts in management.J Am Acad Orthop Surg, 2008, 16(12):716-728.
10.	McKee MD, Jupiter JB, Bamberger HB.Coronal shear fractures of the distal end of the humerus.J Bone Joint Surg (Am), 1996, 78(1):49-54.
11.	[No authors listed].Fracture and dislocation compendium.Orthopaedic Trauma Association Committee for Coding and Classification.J Orthop Trauma, 1996, 10 Suppl 1:v-ix, 1-154.
12.	Mighell M, Virani NA, Shannon R, et al.Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws.J Shoulder Elbow Surg, 2010, 19(1):38-45.
13.	Ring D.Open reduction and internal fixation of an apparent capitellar fracture using an extended lateral exposure.J Hand Surg (Am), 2009, 34(4):739-744.
14.	McKee MD, Veillette CJ, Hall JA, et al.A multicenter, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.J Shoulder Elbow Surg, 2009, 18(1):3-12.
15.	Kuriyama K, Kawanishi Y, Yamamoto K.Arthroscopic-assisted reduction and percutaneous fixation for coronal shear fractures of the distal humerus:report of two cases.J Hand Surg (Am), 2010, 35(9):1506-1509.
16.	Doornberg J, Lindenhovius A, Kloen P, et al.Two and three-dimensional computed tomography for the classification and management of distal humeral fractures.Evaluation of reliability and diagnostic accuracy.J Bone Joint Surg (Am), 2006, 88(8):1795-1801.
17.	Imatani J, Morito Y, Hashizume H, et al.Internal fixation for coronal shear fracture of the distal end of the humerus by the anterolateral approach.J Shoulder Elbow Surg, 2001, 10(6):554-556.
18.	王磊, 陳云豐, 安智全, 等.外側Kaplan入路治療成人肱骨遠端冠狀面骨折.中華骨科雜志, 2011, 31(5):491-495.
19.	蔣協遠, 公茂琪, 張力丹, 等.肱骨小頭移位骨折的手術治療.中華醫學雜志, 2001, 81(5):293-294.
20.	胡曉川, 向明, 陳杭, 等.前向鷹嘴骨折脫位的手術治療.中國修復重建外科雜志, 2012, 26(12):1462-1465.
21.	Lindenhovius AL, Doornberg JN, Brouwer KM, et al.A prospective randomized controlled trial of dynamic versus static progressive elbow splinting for posttraumatic elbow stiffness.J Bone Joint Surg (Am), 2012, 94(8):694-700.

1. Lee JJ, Lawton JN.Coronal shear fractures of the distal humerus.J Hand Surg (Am), 2012, 37(11):2412-2417.
2. Dubberley JH, Faber KJ, Macdermid JC, et al.Outcome after open reduction and internal fixation of capitellar and trochlear fractures.J Bone Joint Surg (Am), 2006, 88(1):46-54.
3. Guitton TG, Doornberg JN, Raaymakers EL, et al.Fractures of the capitellum and trochlea.J Bone Joint Surg (Am), 2009, 91(2):390-397.
4. Brouwer KM, Jupiter JB, Ring D.Nonunion of operatively treated capitellum and trochlear fractures.J Hand Surg (Am), 2011, 36(5):804-807.
5. Durakbasa MO, Gumussuyu G, Gungor M, et al.Distal humeral coronal plane fractures:management, complications and outcome.J Shoulder Elbow Surg, 2013, 22(4):560-566.
6. Broberg MA, Morrey BF.Results of delayed excision of the radial head after fracture.J Bone Joint Surg (Am), 1986, 68(5):669-674.
7. Watts AC, Morris A, Robinson CM.Fractures of the distal humeral articular surface.J Bone Joint Surg (Br), 2007, 89(4):510-515.
8. Ring D, Jupiter JB, Gulotta L.Articular fractures of the distal part of the humerus.J Bone Joint Surg (Am), 2003, 85-A (2):232-238.
9. Ruchelsman DE, Tejwani NC, Kwon YW, et al.Coronal plane partial articular fractures of the distal humerus:current concepts in management.J Am Acad Orthop Surg, 2008, 16(12):716-728.
10. McKee MD, Jupiter JB, Bamberger HB.Coronal shear fractures of the distal end of the humerus.J Bone Joint Surg (Am), 1996, 78(1):49-54.
11. [No authors listed].Fracture and dislocation compendium.Orthopaedic Trauma Association Committee for Coding and Classification.J Orthop Trauma, 1996, 10 Suppl 1:v-ix, 1-154.
12. Mighell M, Virani NA, Shannon R, et al.Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws.J Shoulder Elbow Surg, 2010, 19(1):38-45.
13. Ring D.Open reduction and internal fixation of an apparent capitellar fracture using an extended lateral exposure.J Hand Surg (Am), 2009, 34(4):739-744.
14. McKee MD, Veillette CJ, Hall JA, et al.A multicenter, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.J Shoulder Elbow Surg, 2009, 18(1):3-12.
15. Kuriyama K, Kawanishi Y, Yamamoto K.Arthroscopic-assisted reduction and percutaneous fixation for coronal shear fractures of the distal humerus:report of two cases.J Hand Surg (Am), 2010, 35(9):1506-1509.
16. Doornberg J, Lindenhovius A, Kloen P, et al.Two and three-dimensional computed tomography for the classification and management of distal humeral fractures.Evaluation of reliability and diagnostic accuracy.J Bone Joint Surg (Am), 2006, 88(8):1795-1801.
17. Imatani J, Morito Y, Hashizume H, et al.Internal fixation for coronal shear fracture of the distal end of the humerus by the anterolateral approach.J Shoulder Elbow Surg, 2001, 10(6):554-556.
18. 王磊, 陳云豐, 安智全, 等.外側Kaplan入路治療成人肱骨遠端冠狀面骨折.中華骨科雜志, 2011, 31(5):491-495.
19. 蔣協遠, 公茂琪, 張力丹, 等.肱骨小頭移位骨折的手術治療.中華醫學雜志, 2001, 81(5):293-294.
20. 胡曉川, 向明, 陳杭, 等.前向鷹嘴骨折脫位的手術治療.中國修復重建外科雜志, 2012, 26(12):1462-1465.
21. Lindenhovius AL, Doornberg JN, Brouwer KM, et al.A prospective randomized controlled trial of dynamic versus static progressive elbow splinting for posttraumatic elbow stiffness.J Bone Joint Surg (Am), 2012, 94(8):694-700.

Chinese Journal of Reparative and Reconstructive Surgery

OPERATIVE TREATMENT OF Dubberley TYPE 3B CAPITULUM-TROCHLEA FRACTURES

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