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Fractures of the articular surface of the distal humerus

Includes fracture of the capitellum or trochlea

Capitellum

Background

  • Also called Kocher fracture
  • Rare fractures
  • Often difficult to diagnose if fracture fragment is small

Classification

  • Type 1 (Hahn-Steinthal)
    • Fracture of the capitellum in the coronal plane
    • Involves large part of the osseous portion of the capitellum and may contain part of the trochlea
  • Type 2 (Kocher-Lorenz)
    • Involves articular cartilage (anterior) with little bone attached
  • Type 3
    • Comminuted fracture

Capitellum Fracture classification


Mechanism of Injury

  • Transmission of forces through the radial head
    • Fall onto the hand with elbow in some degree of flexion
    • Fall onto the point of the elbow while it is flexed


Clinical Examination

  • Pain, tenderness and swelling over the lateral aspect of the elbow
  • Bony block to the range of movement
    • Associated with anteriorly displaced fragments (Type 1)
    • Not with posteriorly displaced fragments
  • Limited range of movement
  • Crepitus on movement

Associated injury

  • Radial head fracture
  • Posterior dislocation of the elbow
  • Medial collateral ligament damage (tenderness and swelling over the medial aspect of the elbow with possible valgus instability)

Investigations

  • AP and lateral x-rays of the elbow are needed
  • Best visualised on a lateral view


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