[Osteosynthesis of combined radius head and capitulum humeri fractures with mini-implants]

Combined injuries of the capitellum humeri and the radial head are rare. Most of them show combined osteocartilaginous lesions and collateral ligament lesions. Recommendations for treatment of these fatal injuries of the elbow are missing.

Five cases were investigated in an retrospective analysis. The same approach was used for the osteocartilaginous lesion of the capitellum as well as the injury of the radial head. Internal fixation was done with mini-titanimplants, three of them combined with resorbable pins.

Between 1996-1999 five patients (four men, one woman) with combined injury of the radial head and the capitellum were stabilized. The average age was 34 years (31-40 years). All fractures were stabilized by a direct radial approach with 1.5 mm or 2.0 mm lag screws partly with resorbable pins. All patients were evaluated radiologically and clinically according to the Mayo-elbow-performance score.

All patients were personally examined after an average period of 12.8 month (8-24 month) by an independent investigator. 4/5 patients were assessed for their satisfaction. No radiological signs of avascular necrosis of the capitellum or arthrosis were found. Three patients showed periarticular calcifications. The range of motion was averagely 124 degrees (extension 5-30 degrees, flexion 110-145 degrees), in three of five cases a secondary intervention for improvement of joint mobility was necessary. The Mayo-elbow-performance score rated for 85 points in average (range 70-100 points).

Direct screw fixation with mini-implants, eventually combined with resorbable pins allows to use the same approach for anatomic reconstruction and fixation of the capitellum humeri and radial head. Transarticular fragment fixation of the capitellum allows for safe compression. Therefore early functional rehabilitation is possible postoperatively. Secondary interventions for improve joint motion were necessary in three of five cases.