title: Open reduction and internal fixation combined with hinged elbow fixator in capitellum and trochlea fractures.
abstract: OBJECTIVE
  The current surgical treatment for displaced fracture of the capitellum and trochlea is open reduction and internal fixation (ORIF), but the results are often unsatisfactory, particularly with complex fractures. Furthermore, the surgical approach, the kind of osteosynthesis, and postoperative management are controversial. We evaluated the results of internal fixation combined with hinged external fixation.
  
  
  METHODS
  We analyzed 15 patients with a mean age of 47 (18-65) years. Based on the Bryan-Morrey-McKee classification, the fractures were identified as type I in 6 cases and type IV in 9. Active and passive motion was started and activities of daily living were permitted on the second postoperative day. The mean follow-up time was 29 (12-49) months.
  
  
  RESULTS
  In 13 cases, functional range of motion was obtained within 6 weeks of surgery. At final follow-up, 14 patients had a stable, pain-free elbow with a mean active range of motion of 13 degrees to 140 degrees . The average score on the Mayo elbow performance score was 98.
  
  
  CONCLUSIONS
  The use of the hinged fixator allows early motion of the elbow while preserving joint stability. It may have additional value in complex articular fractures when stable internal fixation cannot be obtained with ORIF, and in the presence of severe ligamentous injuries.
authors.affiliation: Department of Orthopaedic Surgery, University Sapienza of Rome, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giannicola
authors.forename: Federico M
authors.initials: FM
authors.lastname: Sacchetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Greco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gregori
authors.forename: Franco
authors.initials: F
authors.lastname: Postacchini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004551:Elbow Joint / Q000503:physiopathology*; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult