Management of capitellar fractures with open reduction and internal fixation using Herbert screws

Capitellar fractures are rare elbow injuries and can cause severe limitation of function if not properly managed. Numerous treatments have evolved, from closed reduction and cast immobilization to open reduction and internal fixation (ORIF), so as to achieve a stable joint that allows early mobilization. We determined the functional outcomes of treating these fractures with ORIF using Herbert screws via an extensile lateral approach.

Fifteen patients with capitellar fractures were included in this retrospective study. A well taken lateral radiograph was important and stressed upon in all patients. All fractures were open reduced and internally fixed using Herbert screws via an extensile lateral approach over a period of 5 years. Clinical, radiographic, and Mayo Elbow Performance Index were evaluated at a mean followup of 3.6 years (range, 1.5-6 years).

Nine type I and six type IV capitellar fractures were identified using Bryan and Morrey classification system. The average time to bone union was 12 weeks (range 8-16 weeks) with no case of nonunion. The mean range of flexion was 130° (range 125°-135°). The average extensor lag was 10° (range 0°-30°), with a functional range of motion of elbow achieved in all patients. On the final follow-up, one case of osteoarthritis was seen, but no evidence of avascular necrosis or heterotrophic ossification was seen. Two patients needed screw removal. The outcome was excellent in 10 patients and good in five patients.

Herbert screw fixation provides stable fixation in capitellar fractures and good to excellent outcomes with excellent elbow motion, can be achieved following internal fixation of these complex fractures using the extended lateral exposure.