Management and clinical outcomes of Dubberley type A capitellar fractures

Capitellar fractures are uncommon, accounting for 0.5-1 % of all elbow fractures. These fractures are best managed surgically to restore articular congruity. Dubberley type A fractures treated with anterolateral or lateral surgical approaches have been associated with high complication rates. The 'Global' approach to elbow has been conceptualised in order to comprehensively approach elbow injuries. The aim of this study was to evaluate the clinical outcomes of fractures of the capitellum treated using global surgical approach.

Data was prospectively collected for all patients presenting between 1998 and 2020.Patient's demographics, mechanism of injury, Mayo Elbow Performance Index MEPI, Grip Strength and radiographs were retrospectively collected and analysed.

31 patients met the inclusion criteria with a mean age of 47yrs (IQR 12-81yrs) years, 18 males: 13 female patients. According to Dubberley classification, 24 were type I, 5 were type II and 2 were type III. 4 patients sustained associated collateral ligament injuries and 2 patients had radial head fractures. Global approach with an inside Kaplan approach was used in 26 patients, others were treated with an inside Kocher or anterior approaches. Almost all fractures were fixed using headless screws alone (n = 25),6 patients had fixation augmented with bioabsorbable rods or a posterior buttress plate. Mean follow up was 46 months. Mean MEPI was 89 (SD8), Extension 9.35 ± 5.32, Flexion 130.29 ± 8.7, Pronation 59.16 ± 7.034, Supination 63.97 ± 7.1. Mean Grip strength was 22.94 ± 4.5. These were significantly better following surgery (p < 0.001). Further surgery was only required in 1 case for stiffness. Overall complication rate was 9.6 %. There were no infections or cases of instability following fixation.

This study is one of the largest case series reporting good functional outcomes in Dubberley type A fractures treated with headless screws using global surgical approach. We report lowest complication rate,100 % fracture union rate and good MEPI scores.