Herbert screw fixation of capitellar fractures

Abstract

Background Capitellar fractures are rare injuries. Controversy regarding the management of these injuries still continues. If anatomy is not reconstructed accurately, elbow function is suboptimal. The most accepted treatment of capitellar fractures is by open reduction and internal fixation. Recently, Herbert screw system has been recommended for fixation of osteochondral fractures. Objective The aim of this study was to evaluate the outcome of Herbert screw fixation in the treatment of capitellar fractures. Patients and methods Between May 2007 and July 2010, 10 patients with displaced fractures of the humeral capitellum were treated by open reduction and internal fixation of the capitellar fragments with Herbert screws in Benha University Hospital and Benha insurance hospitals. The mean follow-up period was 14 months (range 6-24 months) and the mean age was 37 years (range 20-48 years). Results All patients were evaluated according to the Mayo elbow performance score. Overall, six patients' results were found to be excellent and that of four were good. All patients were satisfied with the operative outcome and had a stable pain-free elbow with good range of motion at follow-up without any avascular necrosis or arthritic changes. The mean extension of the elbow was 7.5° (range 0-20°) and the mean flexion was 132° (range 128-135°). They all had full pronation and supination and had good stability; however, none of them had residual pain. Conclusion Treatment of capitellar fractures by Herbert screw leads to minimal articular damage and rigid fixation with solid union and excellent compression as well as early mobilization. Encountering a free capitellar fragment and nonunion should not discourage the use of internal fixation, as avascular necrosis is less likely to occur with good fixation and early mobilization.