Isolated shear fracture of humeral trochlea

Abstract

A 30-year-old male was involved in a vehicularaccident while driving a scooter and landed onhis outstretched hand with the elbow in extension.He presented to the casualty department with aswollen elbow held in some degree of flexion.Examination revealed tenderness on the medialaspect of the elbow. Movements at the elbow jointwere painfully restricted. There was no associatedneurovascular deficit. Evaluation of radiographsrevealed a half moon shaped fragment lying prox-imal and anterior to the distal humerus simulatinga capitellar fracture in the lateral view. But onanteroposterior view, the fracture appeared toinvolve the trochlea (Fig. 1). The patient wasplanned for open reduction and internal fixationof the fracture. The joint was opened via a medialapproach. The common flexors were detachedfrom the medial epicondyle and the capsule wasincised. The osteochondral fragment was involvingthetrochlea,withthefracturelineextendinginthecoronalplane acrossthemedial trochlear ridgeinto the trochlear notch. The fragment was dis-placed proximally and rotated internally. The frac-ture was reduced and fixed with two 4.0 mmpartially threaded cancellous screws passed fromthe non-articular area. The elbow was immobilisedin a POP back splint and early active range ofmotion exercises were encouraged at 5 days whenthe patient was pain free. A removable splint wasworn for the first 6 weeks during which period thepatient was instructed to carry out the exerciseson his own. Muscle strengthening and further reha-bilitation was initiated after 6 weeks once signs of