Fractures of the Capitellum and Trochlea

Abstract

Capitellar and trochlear fractures are articular injuries of the distal humerus without involvement of the humeral columns. These fractures occur in a bimodal distribution, most commonly after high-energy trauma in young males or ground level falls in elderly females. Open reduction and internal fixation (ORIF) with a variety of implants and exposure techniques is a mainstay of treatment for displaced fractures, while non- or minimally- displaced fractures may be treated non-operatively. Operative management has expanded to include novel arthroscopic and open approaches, such as surgical dislocation of the elbow. Rarely, in elderly patients with severe comminution, total elbow arthroplasty may be the best option. In general, if the capitellar and trochlear injury is appropriately classified, the articular fragments are adequately secured, associated soft tissue injuries are identified and repaired, and a quality therapy program is instituted, patients who sustain these injuries are likely to have a good result with a well-functioning elbow, although complications will occur than 30% of the time.