Current concepts in management of coronal shear fractures of the elbow

Coronal shear fracture of the capitellum is a rare articular injury of the distal humerus and could be burdened by high complications if an accurate reduction is not achieved. This complex lesion is usually displaced and requires open reduction and internal fixation for a better outcome. Better results are reported in isolated radiocapitellar joint fracture, while lower results are associated with trochlear involvement and articular comminution. CT scan is helpful to understand the fracture pattern and for a surgical planning. Several classifications have been proposed, mainly based on topography of the lesion or more management oriented such as Dubberly's classification. Headless screws guarantee a stable fixation but when medial extension of the fracture or comminution are present, an extensible approach and supplemental fixation with cannulated screws or plate are indicated. Fragment excision can be attempted for small fragments difficult to fix, with a higher risk of elbow instability especially if associated lesions are present. Arthroscopic reduction and elbow arthroplasty are also described for selected cases. Anatomical reduction provides high union rates and good elbow function. Complications' rate is approximately 30%, mostly elbow stiffness, and in a minor part pseudoarthrosis and osteonecrosis.