FUNCTIONAL OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION VIA THE ANTERIOR APPROACH FOR CAPITELLUM FRACTURES IN ADULT PATIENTS

Manzoor Ilahi; Muhammad Siraj; Adnan Khan; Waseem Khan; Abbas Ali; Shahab Ur Rehman

doi:10.46903/gjms/24.1.2119

FUNCTIONAL OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION VIA THE ANTERIOR APPROACH FOR CAPITELLUM FRACTURES IN ADULT PATIENTS

Manzoor Ilahi, Muhammad Siraj, Adnan Khan, Waseem Khan, Abbas Ali, Shahab Ur Rehman

Abstract

Background: Capitellum fractures are rare intra-articular injuries of the distal humerus that require anatomical reduction and stable fixation for optimal functional recovery. The anterior approach to the elbow allows direct visualization of the articular surface and may facilitate early mobilization with minimal soft-tissue disruption. The purpose of the present study was to evaluate the clinical and functional outcomes of patients undergoing ORIF of capitellum fractures using headless Herbert screws via the anterior approach at a tertiary care center.

Materials & Methods: This prospective case series study was conducted in the Department of Orthopaedic Surgery, MTI-Khyber Teaching Hospital, Peshawar, from June 2023 to October 2024, involving 29 adult patients (17 male, 12 female) with isolated capitellum fractures. All patients underwent open reduction and internal fixation using headless Herbert screws via the anterior approach. Patients were followed for 6 months. Functional outcome was assessed using the Mayo Elbow Performance Index (MEPI). Data were analyzed using SPSS version 26.0.

Results: The mean age of patients was 33.48 ± 8.58 years. The mean time to radiological union was 11.90 ± 1.29 weeks. The mean flexion-extension arc was 142.77 ± 3.03 degrees, and the mean supination-pronation arc was 165.27 ± 2.03 degrees. The mean MEPI score was 85.24 ± 10.68. According to the MEPI score, 16 (55.2%) patients achieved excellent results, 7 (24.1%) good, 4 (13.8%) fair, and 2 (6.9%) poor outcomes. No cases of avascular necrosis, implant failure, or deep infection were observed.

Conclusion: Open reduction and internal fixation of isolated capitellum fractures using headless Herbert screws via the anterior approach provides excellent to good functional outcomes in the majority of patients with a low complication rate in the short term. This technique is a safe and effective surgical option for adult patients.

Keywords

Anterior Elbow Approach; Bone Screws; Capitulum; Elbow Joint; Herbert screw; Intra-Articular Fractures; Treatment Outcome.

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References

Majeed M, Thahir A, Krkovic M. The operative management of capitellum fractures. Cureus. 2024 Apr 29;16(4). https://doi.org/10.7759/cureus.60212

Watson JJ, Bellringer S, Phadnis J. Coronal shear fractures of the distal humerus: current concepts and surgical techniques. Shoulder Elbow. 2020 Apr;12(2):124–35. https://doi.org/10.1177/1758573219879549

Mukherjee K, Sahu S. Elbow coronal shear injury presenting as a rare fracture triad involving capitellum, lateral condyle, and olecranon—a case report and its pathomechanism. J Orthop Case Rep. 2025 Jun;15(6):39. https://doi.org/10.13107/jocr.2025.v15.i06.4202

Lari A, Alrumaidhi Y, Martinez D, Ahmad A, Aljuwaied H, Alherz M, Prada C. Clinical outcomes and management strategies for capitellum and trochlea fractures: a systematic review. Orthop Res Rev. 2024 Dec 31:179–97. https://doi.org/10.2147/ORR.S456789

Heller M, Abdelaal MS, Adams A, Ilyas AM, Kachooei AR. Rate of complications after capitellum fracture fixation: a systematic review and meta-analysis. J Hand Surg Am. 2025 May 1;50(5):616.e1. https://doi.org/10.1016/j.jhsa.2024.12.003

Yu T, Tao H, Xu F, Hu Y, Zhang C, Zhou G. Management of isolated coronal shear fractures of the humeral capitellum with Herbert screw fixation through anterolateral approach. BMC Musculoskelet Disord. 2018 Apr 5;19(1):108. https://doi.org/10.1186/s12891-018-2043-2

Lamas C, Grau A, Almenara M, Trigo L. Coronal shear fractures of the capitellum and trochlea: interobserver variability in classifying the fracture and the need for a computed tomography scan for the correct surgical planning. JSES Int. 2021 Mar 1;5(2):314–9. https://doi.org/10.1016/j.jseint.2020.12.004

Aggarwal S, Paknikar K, Sinha J, Compson J, Reichert I. Comprehensive review of surgical approaches to the elbow. J Clin Orthop Trauma. 2021 Sep 1;20:101482. https://doi.org/10.1016/j.jcot.2021.101482

Memon K, Awan M, Alsadoun L, Ahmad S, Chan S, Kalogrianitis S, Abro AA. A systematic review of surgical techniques for the repair of capitellar fractures. Cureus. 2025 Mar 27;17(3). https://doi.org/10.7759/cureus.12345

Paneri J, Kala A, Gupta SP. Capitellum fracture: outcome of surgical treatment. Int J Orthop. 2020;6(2):656–60. https://doi.org/10.22271/ortho.2020.v6.i2j.2103

Vaishya R, Vijay V, Jha GK, Agarwal AK. Open reduction and internal fixation of capitellar fracture through anterolateral approach with headless double-threaded compression screws: a series of 16 patients. J Shoulder Elbow Surg. 2016 Jul 1;25(7):1182–8. https://doi.org/10.1016/j.jse.2016.01.020

Hussain S, Ali A, Yusuf MT, Siddique RM. Humeral capitellar fractures fixation with Herbert screws. Pak J Med Health Sci. 2018 Apr 1;12(2):792–5.

Baydar M, Aykut S, Mert M, Keskinbiçki MV, Akdeniz H, Öztürk K. Isolated capitellar fracture fixation with headless screws in different configurations. Acta Ortop Bras. 2022;30:e244357. https://doi.org/10.1590/1413-78522022300244357

Hulet DA, D’Auria JL, Earp BE, Zhang D, Benavent K, Blazar PE. Long-term outcomes and return to work after isolated coronal shear fractures of the capitellum. J Hand Surg Glob Online. 2023 May 1;5(3):310–4. https://doi.org/10.1016/j.jhsg.2023.01.004

Garg S, Sain A, Sharma V, Farooque K, Rangaswamy N. Functional outcome of a coronal shear fracture of the capitellum managed by Herbert screw fixation using the anterolateral surgical approach. Cureus. 2020 Jan 6;12(1). https://doi.org/10.7759/cureus.6649

DOI: https://doi.org/10.46903/gjms/24.1.2119