Capitellum fracture

Background

• Fracture of distal humerus at capitellum
• Rare, occurs in approximately 1% of elbow fractures
• Mechanism: FOOSH
• Often require surgery, with good prognosis

Clinical Features

• Pain, swelling, may have block to flexion / extension

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Distal humerus fracture
• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Biceps tendon rupture/dislocation
• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Pronator teres syndrome
• Septic bursitis

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Evaluation

• Elbow X-ray
  • Fractures are often subtle
  • Best seen on lateral XR
    • Look for abnormal fat pad
    • Look for radiocapitellar line disruption
      • If possible, lateral elbow is shot at 45 degrees to pick up subtle fractures
• Consider CT to further identify fracture / operative planning

Management

• Long arm posterior splint for Operative / Non operative

Non-operative management

• Less than 2mm of displacement

Operative management

• More than 2 mm of displacement
• Capitellum with co-existing trochlea involvement
• Comminuted fracture

Disposition

• Normally outpatient, unless concerning neurovascular injury, open fracture, or coexisting injuries requiring admission

Potential Complications

• Elbow contracture
• Nonunion
• AVN
• Ulnar nerve injury

See Also

• Splinting: Humerus
• Elbow diagnoses
• Elbow Fracture (Main)
• Radial head fracture (peds)

References

• Orthobullets