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Rate of Complications After Capitellum Fracture Fixation: A Systematic Review and Meta-Analysis
Mike Heller1, Mohammad S Abdelaal2, Alexander Adams2
1Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA.
The Journal of Hand Surgery
|November 30, 2023
Summary
Surgical fixation of capitellum fractures can lead to complications like elbow pain and arthritis. The direction of screw insertion impacts risks, with posterior-to-anterior (P-A) placement increasing avascular necrosis rates.
Area of Science:
- Orthopedic surgery
- Trauma surgery
- Upper extremity reconstruction
Background:
- Capitellum fractures are complex elbow injuries requiring surgical intervention.
- Understanding complication rates and risk factors is crucial for patient outcomes.
Purpose of the Study:
- To determine the incidence of complications following surgical fixation of acute capitellum fractures.
- To compare complication rates between anterior-to-posterior (A-P) and posterior-to-anterior (P-A) screw insertion techniques.
Main Methods:
- Systematic review and meta-analysis of 42 studies.
- Searched PubMed, EMBASE, and Scopus for skeletally mature patients.
- Analyzed complication rates and subgrouped by screw insertion direction.
Main Results:
- Common complications include elbow pain (21%), radiocapitellar arthritis (19%), and hardware removal (17%).
- Avascular necrosis rates were higher with P-A screw insertion (29% vs. 11%).
- A-P screw insertion was associated with higher rates of revision fixation and heterotopic ossification.
Conclusions:
- Surgical fixation is recommended for displaced capitellum fractures.
- Patients must be informed about potential complications and the possibility of revision surgery.
