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Type IV capitellum fractures in children
Yvonne-Mary Papamerkouriou1, Pantelis Tsoumpos2, George Tagaris2
1Athens General Children's Hospital "Pan. & Aglaia Kyriakou", Athens, Attica, Greece.
BMJ Case Reports
|August 7, 2019
Summary
Type IV McKee fractures of the capitellum are rare in children. Early diagnosis using the double arc sign on X-ray and CT scans, followed by surgical fixation, is crucial for optimal outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Radiology
Background:
- Capitellum fractures are uncommon, accounting for 1% of all elbow fractures.
- Type IV McKee fractures, involving the trochlea, are particularly rare in pediatric patients.
- Diagnosis can be challenging due to rarity and unique radiographic appearance.
Observation:
- A 14-year-old boy sustained a Type IV McKee fracture after a fall.
- The fracture was identified using the 'double arc sign' on X-ray.
- A CT scan was utilized for detailed preoperative planning.
Findings:
- The fracture was treated with open reduction and internal fixation using two headless compression screws.
- At 6-month follow-up, there were no signs of avascular necrosis.
- The patient achieved full extension with only a 5° loss of flexion.
Implications:
- Anatomic reduction and stable internal fixation are critical for successful treatment of these rare pediatric fractures.
- Early and accurate diagnosis, aided by specific radiographic signs and advanced imaging, improves patient outcomes.
- This case highlights effective management strategies for Type IV McKee fractures in children, promoting functional recovery.
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