Capitellum fractures: should the collateral ligament be repaired primarily?

Area of Science:

• Orthopedic Surgery
• Traumatology
• Elbow Biomechanics

Background:

• Capitellum fractures often involve collateral ligament injuries, creating treatment controversy.
• The necessity of primary repair for these associated ligamentous injuries remains debated.

Purpose of the Study:

• To synthesize current evidence on the management of capitellum fractures with collateral ligament injuries.
• To evaluate outcomes associated with different surgical strategies.

Main Methods:

• A systematic review of Medline, Cochrane, and EMBASE databases up to December 2024.
• Analysis of 15 studies involving 220 patients with capitellum fractures and ligamentous injury.

Main Results:

• Lateral collateral ligament (LCL) injuries were present in 56 cases, with all primary injuries undergoing primary repair.
• Medial collateral ligament (MCL) injuries occurred in 17.5% of relevant cases, with inconsistent treatment reported.
• Follow-up ranged from 1.5 to 17 years, with outcomes including range of motion and instability assessed.

Conclusions:

• Primary repair of the LCL is advised for capitellum fractures with LCL injury or during LUCL release.
• MCL injuries may necessitate primary reconstruction or management with a hinged brace.