CCurative effectivenss of canulated screw fixation combined with artificial bone grafting for adult humeral capitulum-trochlear fracture

Abstract

Objective To study the medium-term results of canulated screw fixation combined with artificial bone support for adult humeral capitulum-trochlear fracture. Methods We chose 16 patients including 3 males and 13 females who had humeral capitulum-trochlear fracture during Mar. 2010 to June 2015 from Department of Orthopedics, the First Affiliate Hospital of Zhengzhou University, and the fracture was typed by AO, Dubberley and Bryan-Morrey classifications. Their age varied from 24 to 69 years old, with an average year of 47.6 years old. The causes of injury were as follows: 3 cases of walking fall, 7 casesof electric bicycle fall, 3 cases during sports, 2 casesof car accident and 1 case of high fall. It took 4 to 11 days from injury to surgery, with an average days of 7.5. With open reduction and cannulated screws fixation, and artificial bone grafting to support subchondral bone when necessary as our treatment modality, all of them started functional exercise two weeks after surgery. We recorded and analyzed the last follow-up symptoms: range of motion, pain score, Mayo elbow score, avascular necrosis, traumatic arthritis and heterotopic ossification. Results Sixteen patients were successfully followed up. The average follow-up time was 34.9 months (24 to 47 months). At the last follow-up, all the fractures were healed, and there were 7 patients with no elbow joint pain, 8 with mild pain, 1 with moderate pain, and no severe pain. The average degree of flexion reached 124° (105°-150°), extension 30.1° (0°-70°), flexion and extension 93.9° 35°-150°). The average forearm pronation reached 72° (60°-85°), and supination 82.8° (75°-90°). All of the patients had no elbow instability, avascular necrosis and internal fixation failure, but had traumatic arthritis to varying degrees. Four of them had different degrees of heterotopic ossification. As for the Mayo elbow performance index, the average score was 85 (55 to 100), among which, 7 cases were excellent, 6 cases were good, 2 cases were middle, and 1 case was poor. Conclusion Though humeral capitulum-trochlear fracture has low incidence, it can cause harmful consequences like ankylosis of elbow and traumatic arthritis. Local artificial bone grafting can provide good bone substance for internal fixation when compression and crushing happen to fracture end. Most patients can get excellent prognosis through active surgical treatment and rehabilitation. Key words: Humeral capitulum fracture; Trochlear fracture; Internal fixation; Artificial bone grafting