Clinical treatment of dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUO Hao ^1,2 , ZHU Yong ^1,2 ,  CHENG Liang ^1,2

1. Department of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P. R. China;
2. National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Changsha Hunan, 410008, P. R. China;

Corresponding?author：

CHENG Liang, Email: doccheng@csu.edu.cn

Keywords：

Elbow dislocation; dorsal avulsion fracture of the capitellum; injury mechanism; Osborne-Cotterill lesion

DOI：

10.7507/1002-1892.202108029

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Objective To analyze the possible injury mechanisms in patients with dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint, and to discuss their treatment and prognosis. Methods Retrospective analysis was made on the clinical data of 4 patients with dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint admitted between September 2014 and September 2020, including 3 males and 1 female with an average age of 20.7 years (range, 13-32 years). There were 2 cases of dorsal avulsion fracture of the capitellum combined with medial dislocation of the elbow joint and 2 cases of dorsal avulsion fracture of the capitellum and anterior medial fracture of the coronoid process combined with posterior medial subluxation of the elbow joint. Closed reduction was performed in 3 patients with fresh fracture combined with dislocation, then 2 cases were fixed with tension band and 1 case was fixed with tension band combined with Acumed coronoid anatomic plate. And in patient with old fracture nonunion, the coronoid process was fixed with 1 screw, then the humeral sclerotic bone mass was removed, and finally the lateral collateral ligament was repaired and a hinged external fixator was added. Results All the incisions healed by first intention without early complications such as infection or peripheral nerve injury. The 4 patients were followed up 13-30 months (mean, 20.8 months). The fractures all healed with a healing time of 70-90 days (mean, 79.5 days). At 6 months after operation, heterotopic ossification was seen in the posterior aspect of the right elbow joint in 1 case, and the alkaline phosphatase level was normal (67 U/L); the tension band was removed to clear the heterotopic ossification and the elbow joint was released. The rest of the patients had no heterotopic ossification. At last follow-up, all patients had good functional recovery of the elbow joint, with a Mayo score of 85-100 (mean, 92.5), and the excellent and good rate was 100%. The elbow flexion range of motion was 120°-135°, the extension range of motion was 10°-20°, and the pronation and supination range of motion were all 75°-85°. Conclusion Dorsal avulsion fractures of the capitellum combined with medial or posterior medial dislocation of the elbow may be due to simple varus stress. If an anteromedial coronoid facet fracture also occurs, it may be for the varus posteromedial rotatory instability, which is the opposite mechanism to that of an Osborne-Cotterill lesion. For fresh dorsal avulsion fractures of the capitellum, tension band fixation can be used with good results.

Citation： LUO Hao, ZHU Yong, CHENG Liang. Clinical treatment of dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 149-154. doi: 10.7507/1002-1892.202108029 Copy

1.	Tarallo L, Novi M, Porcellini G, et al. Surgical tips and tricks for coronal shear fractures of the elbow. Arch Orthop Trauma Surg, 2021, 141(2): 261-270.
2.	Jeon IH, Micic ID, Yamamoto N, et al. Osborne-cotterill lesion: an osseous defect of the capitellum associated with instability of the elbow. AJR Am J Roentgenol, 2008, 191(3): 727-729.
3.	Somford MP, van den Bekerom MPJ, Gosens T, et al. The Osborne-Cotterill lesion: How an eponymous term arose and evolved. J Bone Joint Surg (Am), 2019, 101(16): e81. doi: 10.2106/JBJS.18.01284.
4.	McKee MD, Schemitsch EH, Sala MJ, et al. The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg, 2003, 12(4): 391-396.
5.	Capo J, Khamsi B, Nourbakhsh A. Posterolateral instability of the elbow in an adolescent boy with a lateral epicondyle fracture: a case report. Hand (N Y), 2011, 6(1): 71-75.
6.	Barco R, Antu?a SA. Management of elbow trauma: Anatomy and exposures. Hand Clin, 2015, 31(4): 509-519.
7.	Elhassan B, Karabekmez F, Hsu CC, et al. Outcome of local anconeus flap transfer to cover soft tissue defects over the posterior aspect of the elbow. J Shoulder Elbow Surg, 2011, 20(5): 807-812.
8.	Osborne G, Cotterill P. Recurrent dislocation of the elbow. J Bone Joint Surg (Br), 1966, 48(2): 340-346.
9.	Vargas DG, Woodcock S, Porto GF, et al. Osborne-Cotterill lesion a forgotten injury: Review article and case report. Clin Shoulder Elb, 2020, 23(1): 27-30.
10.	Valencia M, Barco R, Antu?a SA. Elbow instability secondary to lateral epicondylar nounion in an adult. J Orthop Traumatol, 2013, 14(4): 311-314.
11.	Patiño JM, Torres Moirano JM. Engaging posterior capitellum fracture and elbow posterolateral rotatory instability: Is it always necessary to treat the bone defect? Case Rep Orthop, 2020, 2020: 3260106. doi: 10.1155/2020/3260106.
12.	Downham C, Lawrence T. Acute and chronic elbow instability: a review of mechanisms, patho-anatomy and management. Orthopaedics and Trauma, 2020, 34(4): 197-205.
13.	Robinson PM, Griffiths E, Watts AC. Simple elbow dislocation. Shoulder Elbow, 2017, 9(3): 195-204.
14.	Rhyou IH, Kim YS. New mechanism of the posterior elbow dislocation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(12): 2535-2541.
15.	Rhyou IH, Lee JH, Lee JH, et al. Soft tissue injury patterns in posteromedial rotatory instability with dislocation compared with posteromedial dislocation of the elbow joint. J Shoulder Elbow Surg, 2020, 29(6): 1259-1266.
16.	Jockel CR, Katolik LI, Zelouf DS. Simple medial elbow dislocations: a rare injury at risk for early instability. J Hand Surg (Am), 2013, 38(9): 1768-1773.
17.	Park SM, Lee JS, Jung JY, et al. How should anteromedial coronoid facet fracture be managed? A surgical strategy based on O’Driscoll classification and ligament injury. J Shoulder Elbow Surg, 2015, 24(1): 74-82.
18.	Ramirez MA, Stein JA, Murthi AM. Varus posteromedial instability. Hand Clin, 2015, 31(4): 557-563.
19.	McLean J, Kempston MP, Pike JM, et al. Varus posteromedial rotatory instability of the elbow: Injury pattern and surgical experience of 27 acute consecutive surgical patients. J Orthop Trauma, 2018, 32(12): e469-e474.

1. Tarallo L, Novi M, Porcellini G, et al. Surgical tips and tricks for coronal shear fractures of the elbow. Arch Orthop Trauma Surg, 2021, 141(2): 261-270.
2. Jeon IH, Micic ID, Yamamoto N, et al. Osborne-cotterill lesion: an osseous defect of the capitellum associated with instability of the elbow. AJR Am J Roentgenol, 2008, 191(3): 727-729.
3. Somford MP, van den Bekerom MPJ, Gosens T, et al. The Osborne-Cotterill lesion: How an eponymous term arose and evolved. J Bone Joint Surg (Am), 2019, 101(16): e81. doi: 10.2106/JBJS.18.01284.
4. McKee MD, Schemitsch EH, Sala MJ, et al. The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg, 2003, 12(4): 391-396.
5. Capo J, Khamsi B, Nourbakhsh A. Posterolateral instability of the elbow in an adolescent boy with a lateral epicondyle fracture: a case report. Hand (N Y), 2011, 6(1): 71-75.
6. Barco R, Antu?a SA. Management of elbow trauma: Anatomy and exposures. Hand Clin, 2015, 31(4): 509-519.
7. Elhassan B, Karabekmez F, Hsu CC, et al. Outcome of local anconeus flap transfer to cover soft tissue defects over the posterior aspect of the elbow. J Shoulder Elbow Surg, 2011, 20(5): 807-812.
8. Osborne G, Cotterill P. Recurrent dislocation of the elbow. J Bone Joint Surg (Br), 1966, 48(2): 340-346.
9. Vargas DG, Woodcock S, Porto GF, et al. Osborne-Cotterill lesion a forgotten injury: Review article and case report. Clin Shoulder Elb, 2020, 23(1): 27-30.
10. Valencia M, Barco R, Antu?a SA. Elbow instability secondary to lateral epicondylar nounion in an adult. J Orthop Traumatol, 2013, 14(4): 311-314.
11. Patiño JM, Torres Moirano JM. Engaging posterior capitellum fracture and elbow posterolateral rotatory instability: Is it always necessary to treat the bone defect? Case Rep Orthop, 2020, 2020: 3260106. doi: 10.1155/2020/3260106.
12. Downham C, Lawrence T. Acute and chronic elbow instability: a review of mechanisms, patho-anatomy and management. Orthopaedics and Trauma, 2020, 34(4): 197-205.
13. Robinson PM, Griffiths E, Watts AC. Simple elbow dislocation. Shoulder Elbow, 2017, 9(3): 195-204.
14. Rhyou IH, Kim YS. New mechanism of the posterior elbow dislocation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(12): 2535-2541.
15. Rhyou IH, Lee JH, Lee JH, et al. Soft tissue injury patterns in posteromedial rotatory instability with dislocation compared with posteromedial dislocation of the elbow joint. J Shoulder Elbow Surg, 2020, 29(6): 1259-1266.
16. Jockel CR, Katolik LI, Zelouf DS. Simple medial elbow dislocations: a rare injury at risk for early instability. J Hand Surg (Am), 2013, 38(9): 1768-1773.
17. Park SM, Lee JS, Jung JY, et al. How should anteromedial coronoid facet fracture be managed? A surgical strategy based on O’Driscoll classification and ligament injury. J Shoulder Elbow Surg, 2015, 24(1): 74-82.
18. Ramirez MA, Stein JA, Murthi AM. Varus posteromedial instability. Hand Clin, 2015, 31(4): 557-563.
19. McLean J, Kempston MP, Pike JM, et al. Varus posteromedial rotatory instability of the elbow: Injury pattern and surgical experience of 27 acute consecutive surgical patients. J Orthop Trauma, 2018, 32(12): e469-e474.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical treatment of dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint

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