Capitellum fracture

Background

  • Fracture of distal humerus at capitellum
  • Rare, occurs in approximately 1% of elbow fractures
  • Mechanism: FOOSH
  • Often require surgery, with good prognosis

Clinical Features

  • Pain, swelling, may have block to flexion / extension

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

Radiograph-Negative

Pediatric

Evaluation

  • Elbow X-ray
    • Fractures are often subtle
    • Best seen on lateral XR
      • Look for abnormal fat pad
      • Look for radiocapitellar line disruption
        • If possible, lateral elbow is shot at 45 degrees to pick up subtle fractures
  • Consider CT to further identify fracture / operative planning

Management

Non-operative management

  • Less than 2mm of displacement

Operative management

  • More than 2 mm of displacement
  • Capitellum with co-existing trochlea involvement
  • Comminuted fracture

Disposition

  • Normally outpatient, unless concerning neurovascular injury, open fracture, or coexisting injuries requiring admission

Potential Complications

  • Elbow contracture
  • Nonunion
  • AVN
  • Ulnar nerve injury

See Also

References