An unusual pediatric capitellar-trochlear shear fracture: a case report and narrative review

Capitellum fracture (CF) of the distal humerus is an unusual and rare pediatric fracture. CF is not only confined to the capitellum but can extend into the trochlea. Treatment options vary from casting to surgical fixation based on displacement and fracture characteristics.

A 13-year-5-month-old boy who presented after a fall on his left elbow was found to have a displaced coronal shear CF extending into the trochlea, type 4 McKee fracture/type 2A Dubberley. An open reduction and internal fixation (ORIF) was performed through a lateral approach using headless compression Herbert screws directed from anterior to posterior. Stable fixation without mechanical block or crepitation was tested through the full arc of elbow motion. Postoperatively, a posterior splint in 90° elbow flexion was applied to maintain fracture reduction.

CF requires ORIF to restore articular congruency and minimize associated complications of union, avascular necrosis, malalignment, prolonged immobilization, and decreased elbow range of motion. Clinicians need to be vigilant in their diagnosis, assessment, and treatment of capitellar and trochlear fractures to avoid suboptimal treatment and lifelong complications.

In view of the heightened risk of complications secondary to suboptimal treatment, a deliberate understanding of CF and careful assessment are necessary to provide the best treatment approach. Timely and accurate diagnosis of CF is crucial to restore congruity, joint stability, and minimize complications.