It is formed by the subchondral bone of the capitellum and the lateral trochlear ridge, typically rotated and displaced in a proximal direction. Fractures of the humeral trochlea journal of shoulder and elbow. Lateral humeral condyle fracture radiology reference. As with other frontline fractures of the distal end of the humerus, such as the capitulum, we recommend open reduction and internal fixation for displaced fractures, with excision of the small osteochondral fragments that do not permit any osteosynthetic repair. Patients were operated on through a medial approach. Spirals around the humerus posteriorly, and reenters the anterior compartment laterally le to power the wrist and finger extensors the radial nerve is very susceptible to injury with any midshaft humerus fracture because it is fixed in the intermuscular septum, the nerve can become trapped when reduction is attempted. Delayed surgical management of an isolated trochlear. From ring et al for very distal comminuted fractures. The fracture can be underestimated on plain films and may be seen as a small sliver of bone adjacent to the proximal border of the capitellum. Computed tomography outlines the fracture pattern and helps to rule out other bony injury, but cannot reveal the articular cartilage damage, which is a mjor predictor of outcome. Trochlea of humerus part of the elbow hinge joint with the ulna.
To the best of our knowledge, only 15 cases have been published. These injuries result from axial loading of the capitellotrochlear area by the forces transmitted through the radial head and could be associated with more complex distal humeral fractures and dislocation with concomitant ligamentous injuries1,3. Coronal articular fractures of the distal humerus usually. Humerus, proximal, articular fracture with slight displacement 11c1 1. This location corresponded to the medial tip of the capitellar epiphyseal ossification center and was not actually on the trochlear ossification center. They are a completely different entity to a lateral epicondyle avulsion fracture where the ossification center is avulsed epidemiology. Trochlea of humerus definition of trochlea of humerus by. Fractures 143 sex men 21 women 122 side left 75 right 68 nerve injury 96 men 15 women 81 type of fracture neer class i93 ii 1 iiia 12 iiib 9 iiic 7 iv2 5 iv3 4 iv4 3 v2 1 vi2a 2 vi4a 2 caput 4 means all fractures n 143 age y 95% ci 68. Milch classification lateral humeral condyle fracture weiss classification lateral humeral condyle fracture bado classification of monteggia fracturedislocations radiusulna mason classification radial head fracture frykman classification distal radial fracture mayo classification scaphoid fracture. Treatment of distal humerus fractures acta chirurgiae. Distal humerus fractures orthopaedic trauma association. Articular fractures of the distal humerus emconsulte.
Management of distal humeral coronal shear fractures ncbi. An impact fracture, often the result of a humeral fracture, is where one bone fragment is driven into the spongy bone of another bone fragment. Isolated shear fracture of humeral trochlea request pdf. The mechanism of injury usually involves falling on an outstretched arm, which causes direct axial compression that is transmitted across the joint, resulting in coronal shear fracture of the capitellum and trochlea. Trochlear deformity occurring after distal humeral. Trochlea of femur forming the knee hinge joint with the patella. A fishtail deformity is one of the wellknown complications following pediatric lateral condyle or supracondylar fractures of the humerus.
Capitellum, fractures, minilocking plate, internal fixator. Trochlea of humerus the trochlea has the capitulum located on its lateral side and the medial epicondyle on its medial. When the forces have more effect on the humerus, the extreme valgus will result in a fracture of the lateral condyle. Humeral condyle fracture radiology reference article. Open reduction and internal fixation by various approaches and implants is advocated. Trochlear fractures reported in the literature were the result of both highenergy for example, a road traffic accident and lowenergy falls traumas. In the human arm, the humeral trochlea is the medial portion of the articular surface of the elbow joint which articulates with the trochlear notch on the ulna in the forearm. Isolated fracture of the trochlea is a rarely reported entity. Capitellar fractures extending to the trochlea may be detected by a pathognomonic radiographic feature visible on the lateral view and called doublearc sign. The distribution of the fractures in the parison of the angle between the trochlear axis.
There is limited information about the functional outcome of patients managed with open reduction and. An isolated displaced coronal shear fracture of humeral. He had a transient fishtail deformity of the trochlear groove after open reduction and internal fixation. Jan 02, 2017 introduction fracture of distal humerus which is proximal to bone masses of the trochlear and capitulum. A comparison of orif and primary tea in the treatment of intraarticular distal humerus fractures in women older than age 65. The structure indicated is the trochlea of the humerus the distal end of the humerus consists of several features. Capitellar and trochlear fractures are uncommon fractures of the distal aspect of the humerus.
Coronal shear fracture of trochlea is rare because of deep location within the elbow joint and forces transmitted through coronoid of ulna are. Mckee10 is typically described as double arc sign on lateral view but this sign is not pathognomonic of this type as it may not be present in all cases. This fracture typically occurs in children younger than 2 years and can be misdiagnosed as elbow dislocation on radiographs 17. We report the case of a patient with an isolated fracture of the. Therefore, in some lateral humeral condyle fractures, the lateral crista of the trochlea may be part of the fracture fragment, leading to an unstable humeral ulnar articulation. The radiographic evaluation and better understanding by computed tomography helps in the management of these technically challenging fractures. Delayed surgical management of an isolated trochlear fracture of the elbow a gomati, p domos, p crossman ipswich hospital nhs trust, uk abstract we present a rare case of a 23yearold man with an isolated trochlear fracture following an injury to the left elbow.
Capitellum trochlea coronal shear fracture distal humerus. Table 1 shows that an isolated fracture of the humeral trochlea has no specific characteristics. Type 5 is a type 4 with fracture of medial condyle osteoporoticbone can be associated with undisplaced supercondylar fx. In type i fractures, the fracture line courses lateral to the trochlea and passes through the capitello trochlear groove. Coronal fractures of the distal humerus may involve the capitellum andor trochlea. Isolated coronal shear fractures of the capitellum or trochlea ao type b3 are relatively rare injuries and account for a small percentage of distal humerus fractures 52. Isolated capitellum fractures are the result of compression of the articular surface by the radial head as if. Type 5 is a type 4 with fracture of medial condyle. Gupta, raj bahadur department of orthopaedics, government medical college and hospital, sector 32b, chandigarh 160030, india accepted 24 september 2004 introduction isolated fractures of the trochlea of humerus are rare. The physis of the lateral condyle extends into the trochlear notch of the distal humerus see the image below. On the medial side the valgus force can lead to avulsion of the medial epicondyle. The full text of this article is available in pdf format. Capitellar and trochlear fractures are infrequent partial articular fractures of the distal humerus.
Associated injuries are medial epicondyle and chip fracture. Coexisting soft tissue or bony injuries are common with 60% of patients with coronal shear fractures also having lateral collateral ligament. Fracture of distal humerus usually involves capitellum and variable part of trochlea. Management of lateral humeral condylar mass fractures in children. Figure 4 type 4 capitellotrochlear fracture with medial epicondyle and olecranon chip fracture in adolescnt. Trochlea of humerus part of the elbow hinge joint with the ulna trochlea of femur forming the knee hinge joint with the patella. This work will significantly advance our understanding.
Type 2 is a type 1 with comminution of lateral condyle. A fracture of the distal humerus, proximal to the epicondyles occurs in the 510 yr olds, rarely occurs 15 yrs, this is. Fourteenyearold male presented with left elbow type 4 capitellum fracture after road traffic accident. Milch described the more common type ii injury as a fracturedislocation and the type i injury as a. In humans and apes it is trochleariform or trochleiform, as opposed to cylindrical in most monkeys and conical in some prosimians. They also persisted up to 4 to 7 years latest followup in an intermediate followup group and eventually reossified by skeletal maturity in a longterm follow. Coronal shear fractures of the distal humerus are rare, complex fractures. Intraarticular hematoma may displace me posterior fat pad of the distal humerus the fat pad sign, which may be the only demonstrable change in an undisplaced or spontaneously reduced fracture. The best view to see the lateral condyle fracture is an internal oblique and this. We herein report a case of medial condyle fracture kilfoyle type iii in an 11yearold boy. It refers to a grooved structure reminiscent of a pulleys wheel. It refers to a grooved structure reminiscent of a pulleys wheel related to joints. Bony defects on the medial 17 patients and central 1 patient regions of the trochlea were observed at a mean of 3. The medial portion of the articular surface of distal humerus is named the trochlea, and presents a deep depression between two wellmarked borders.
In type i fractures, the fracture line courses lateral to the trochlea and passes through the capitellotrochlear groove. This is an enhanced pdf from the journal of bone and joint surgery. Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. This is usually due to the force of a fall on the hand. We diagnosed the patient with a medial condyle fracture of the humerus salterharris 8 type iv, milch type 9 i, and kilfoyle type 5 iii. These types of fractures include a very wide pattern of lesions ranging from relatively simple lesions that interest only the capitellum, with good subchondral bone, that can be treated with screw fixation through anatomical approaches, to very complex fractures with extensive. The fracture through the lateral condyle will have a large cartilaginous component as well as the small osseous portion. Capitellar and trochlear fractures are uncommon partial articular fractures of the distal humerus. Coronal fracture of the distal humerus at capitellum. Trochlea of humerus musculoskeletal, skeletal anatomyzone. Trochlea definition of trochlea by medical dictionary. It is directly inferior to the coronoid fossa anteriorly and to the olecranon fossa posteriorly.
Milch described the more common type ii injury as a fracture dislocation and the type i injury as a simple fracture. Distal humeral epiphyseal separation in young children. Distal humerus fractures remain a challenging inju. These fractures are rare and challenging to manage. The humerus is a long bone of the upper limb, which extends from the shoulder to the elbow the proximal aspect of the humerus articulates with the glenoid fossa of the scapula, forming the glenohumeral joint. Coronal shear fractures of the distal humerus involving capitellum and trochlea account for less than 1% of elbow fractures1,2. Pdf background distal humerus fractures constitute 2% of all fractures in the.
Statistics regarding the incidence of bicolumn fracture vary in the literature from a low of 5% of all distal humerus fractures10 to a high of 62%. The treatment of these rare fractures is challenging. Distal humerus fractures orif capitellum and capitellartrochlear shear fractures. Also note location of sulcus for ulnar nerve in relation to placement of medial plate, as well as location of radial nerve sulcus in relation to proximal placement of plates. Introduction fracture of distal humerus which is proximal to bone masses of the trochlear and capitulum. All the cases were milch type i fractures 8, with one case having a neglected fracture of the trochlear fragment only. Lateral humeral condyle fractures are usually simply termed lateral condyle fractures. The position of the elbow was variable, bent in some cases, extended in others table 1. Most commonly, trochleae bear the articular surface of saddle and other joints. Mckee10 is typically described as double arc sign on lateral view but this sign is not pathognomonic of this type as it may not. These injuries result from axial loading of the capitello trochlear area by the forces transmitted through the radial head and could be associated with more complex distal humeral fractures and dislocation with concomitant ligamentous injuries1,3. Figure 4 type 4 capitello trochlear fracture with medial epicondyle and olecranon chip fracture in adolescnt. Pdf coronal plane fractures of the distal humerus involving the.
On lateral view isolated capitellar fracture appears as halfmoon shaped fragment lying free12. When 2 years old, he had immediate open reduction of a lateral humeral condylar fracture. Type 1 involving primarily the capitellum with or without lateral trochlear ridge. After the closure ouf the epiphyseal lines, i an analogous com figure 2.
The spoolshaped trochlea interposes between the medial and lateral column of the distal end of the humerus and is essential for stability and arc of motion of the elbows. Distal humerus fractures orif capitellum and capitellar trochlear shear fractures. Distal humerus fractures orif capitellum and capitellar. Capitellum and trochlea fractures are commonly associated with concomitant injuries. Coronal plane fractures of the distal humerus involving the capitellum and trochlea are rare. When the greater tubercle is pulled away from the head of the humerus the result in an avulsion fracture. Four men and one woman aged 25 to 46 mean, 34 years underwent cancellous screw n3 or kirschner wire n2 fixation for anterior coronal fractures of the humeral trochlea after falling on a flexed elbow. Distally, at the elbow joint, the humerus articulates with the head of the radius and trochlear notch of the ulna in this article, we shall look at the anatomy of the humerus its. Delayed surgical management of an isolated trochlear fracture.
Four of these cases reported with significant periods of delay. Treatment of capitellar and trochlear fractures with. The mechanisms generating this fracture are complex. Medial condyle fracture kilfoyle type iii of the distal. Open reduction and internal fixation of capitellar fractures with. Trochlear deformity occurring after distal humeral fractures. Capitellar and trochlear fractures musculoskeletal key. Note medial and lateral columns, connected by trochlea, thus forming triangle of distal humerus. Furthermore, the ulnohumeral joint is subjected to very light compressive and shear forces compared to those experienced by the radiohumeral joint, which explains the high frequency of capitellar fractures compared to trochlear fractures. Delayed management of fracture of the lateral humeral.
Pdf coronal shear fracture of the humeral trochlea. Supracondylarfractureofthe humerus 227 group i group 111 group i1 group iv group v longitudinal axis of the humerus was measured according to baumann 1929. Jan 03, 2019 the physis of the lateral condyle extends into the trochlear notch of the distal humerus see the image below. Coronal shear fracture of trochlea is rare because of deep location within the elbow joint and forces transmitted through coronoid of ulna are compressive rather than shearing and has no ligament. Often runs through the apices of coronoid and olecranon fossae, just above the fossae or through the metaphysis of humerus. Management of lateral humeral condylar mass fractures in. To our knowledge, there are only a few cases previously reported in the literature. In the type ii injury, the fracture line extends into the apex of the trochlea. Pdf distal humeral fracturescurrent concepts researchgate. Distal humerus epiphyseal separation transphyseal distal humeral fracture is rare and has been described only in case reports and small case series.