Neglected McKee fracture of the capitellum in a child: Case report

Capitellar fractures of the humerus are extremely rare in children, representing only about 1% of pediatric elbow fractures, and neglected cases are even more exceptional. This report describes a unique case of a 7-month-old neglected type IV capitellar fracture in a 12-year-old girl, highlighting the therapeutic challenges and the outcomes of delayed management.

A 12-year-old girl presented with a 7-month-old neglected capitellar fracture following a fall on an outstretched hand. The injury was initially misdiagnosed and treated with splint immobilization. On examination, she had marked elbow stiffness (extension -70°, flexion 90°) with preserved pronation-supination, no neurovascular defi and a Mayo Elbow Performance Score (MEPS) of 65. Imaging revealed a type IV McKee fracture with callus formation, confirming its chronic nature. Open reduction and internal fixation were performed through a lateral (Kocher) approach using two anterior-to-posterior Herbert screws after anterior capsulectomy. Early rehabilitation began after one week. At 12-month follow-up, flexion improved to 110°, extension to -40°, and MEPS reached 95. Radiographs showed no signs of avascular necrosis or osteoarthritis.

Even in neglected cases, anatomical reduction and stable fixation can achieve favorable outcomes in pediatric capitellar fractures. Capitellar resection should be avoided in children due to the risk of osteoarthritis. Delay in management primarily affects functional recovery rather than increasing the risk of avascular necrosis or degenerative changes. This case underlines that preservation and fixation of the fragment, coupled with early rehabilitation, remain the treatment of choice, even after prolonged neglect.