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American Association for Hand Surgery

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Type IV Capitellum Fractures Have Worse Outcomes Than Types I, II, III
Daniel Yang Hong, MD, Chimere O Ezuma, BA, Liana J Tedesco, MD and Melvin P Rosenwasser, MD, Columbia University Medical Center, New York, NY

Introduction
Capitellum fractures are rare. Fracture displacement can result in loss of motion of the radiocapitellar joint and necessitates fixation. These were classically described by Bryan and Morrey and later McKee's modification of Type IV fractures (coronal shear involving the trochlea as well). We aim to demonstrate surgical outcomes of Type IV capitellum fractures.

Methods
Retrospective chart review was used to identify patients from a single, tertiary care center over a 23 year period (1997-2020). Inclusion criteria included age > 18 years, surgical fixation of capitellum fracture, and post-operative follow-up. Surgical fixation of these fractures typically consisted of headless compression screws for Type I, II fractures and plate augmentation for Type III, IV fractures.

Results
25 patients met inclusion criteria. The most common fracture was Type IV (9 Type I, 1 Type II, 2 Type III, 13 Type IV). 4 patients had concomitant involvement of the lateral epicondyle and 2 of the radial head. Patients with a Type IV fracture compared to those with other types, respectively, had a higher median age (53 vs 46 years), incidence of right sided fractures (46% vs 17%), incidence of fractures of the dominant arm (46% vs 17%), and male incidence (46% vs 8%). Median follow-up for Type IV fractures was 314 days compared to 182.5 days for Types I, II, and III. Type IV fractures were more likely to require subsequent revision surgery than those with other types of fractures (p=0.003) and had lower range of motion after surgery (p=0.004) (Figure 1). This remained true after revision surgery (117.5 degrees vs 130 degrees). No patient had revision surgery for loss of reduction, nor was anyone noted to have osteonecrosis.

Conclusions
This is one of the largest cohorts of Type IV capitellum fractures reported in the literature. Type IV fractures statistically have worse range of motion and higher revision surgery rate than those with Type I, II, and III fractures. All reductions were stable without need for subsequent revision fixation, and no cases of osteonecrosis were noted despite the devascularizing nature of these injuries.


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