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synonyms:capitellar fracture, distal humerus fracture, fracture of humerus, condyle unspecified, articular process NO, lower epiphysis, Osborne-Cotterill lesion, posterior capitellar osteochondral fracture.
Capitellar Fracture ICD-10
A- initial encounter for closed fracture
B- initial encounter for open fracture
D- subsequent encounter for fracture with routine healing
G- subsequent encounter for fracture with delayed healing
K- subsequent encounter for fracture with nonunion
P- subsequent encounter for fracture with malunion
S- sequela
Capitellar Fracture ICD-9
- 812.44 (fracture of humerus, condyle unspecified, articular process NO, lower epiphysis)
Capitellar Fracture Etiology / Epidemiology / Natural History
- Isolated capitellar fractures are uncommon.
- Women < men
- Mechanism of injury: When elbow is hyperextended the radial head forcefully shears off the capitellum during posterior dislocation.
Capitellar Fracture Anatomy
- Capitellar fractures often have extension into the trochlea (Buitton TG, JBJS 2009;91A:390).
- see Elbow Anatomy.
Capitellar Fracture Clinical Evaluation
Capitellar Fracture Xray / Diagnositc Tests
- A/P, lateral and oblique views of the elbow demonstrate fracture.
- CT scan: typically indicated to fully asses fracture. 3D reconstructions with radius and ulna subtracted are beneficial.
Capitellar Fracture Classification / Treatment
- Type I (Hahn-Steinthal / capitellar shear fracture): ORIF
- Type II (Kocher-Lorenz / cartilage and thin layer of subchondral bone sheared off): arthroscopic fragment excision +/- microfracture
- Type III (comminution or compression of the articular surface): arthroscopic fragment excision +/- microfracture.
- Osborne-Cotterill lesion: osteochondral fracture in the posterolateral margin of the humeral capitellum generally associated with a radial head defect of the radial head and elbow dislocation. Treatment = HemiCap (off label) or osteochondral grafting.
Capitellar Fracture Associated Injuries / Differential Diagnosis
Capitellar Fracture Complications
Capitellar Fracture Follow-up Care
- Post-op: compressive dressing, elevation
- 1 week: Start PT focused on ROM and strengthening. AAROM, PROM. AROM, free weights start at 3 weeks.
- 6 weeks: progressive sport specific activity.
- 3 months: Return to sport / full activities.
- Elbow Arthroscopy Rehab Protocol
- Elbow Outcome Measures
Capitellar Fracture Review References
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