Capitellum and Capitellar–Trochlear Shear Injury in Children

Objectives: We report our clinical results following surgical intervention for capitellar fractures in a pediatric population, highlighting approaches, surgical instruments, and possible prognostic factors. Design: Retrospective descriptive case-series study. Setting: A tertiary referral hospital. Patients: Twelve pediatric patients with capitellar or capitellar-trochlear injuries were treated between 2017 and 2021. Intervention: Open reduction and internal fixation primarily using cannulated headless screws. Main Outcome Measurements: The mean follow-up period was 22 months (range: 10–35 months). Functional outcomes were assessed using the Mayo Elbow Performance Score. Post-traumatic elbow arthrosis was assessed using the Bromberg and Morrey rating system. Results: All fractures healed within 5–7 weeks. The mean Mayo Elbow Performance Score value was 98 (range, 85–100). Three patients developed arthrosis, and one had capitellar osteonecrosis. Conclusions: Based on our experience, the Kocher approach and fixation of 2–3 retrograde cannulated screws together represent an appropriate surgical technique for isolated capitellar fractures, whereas good functional outcomes are attainable for capitellar–trochlear shear fractures using the transolecranon approach with 3 cannulated screw fixations. Further injuries to the osseoligamentous structures around the elbow joint are suspected to be an unfavorable prognostic factor. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.