title: Shear fractures of the distal humerus: Is the use of intra-articular screws a safe treatment?
abstract: BACKGROUND
  Coronal shear fractures of the distal humerus are uncommon injuries and are not exempt from complications. The aim of this research is to evaluate the possible advantages and drawbacks using cannulated compression headless screws.
  
  
  METHODS
  We performed a prospective study including all the consecutive patients who were treated with cannulated screws for coronal shear fractures of the distal humerus between 2010 and 2013. Following the Dubberley's classification, three patients were type 1A, one patient was 1B, three patients were 2B, and one patient was 3B. The mean follow-up was 30 months. The clinical and radiological evaluation included analysis of passive range of motion, functional outcome, radiological evaluation of fracture healing and reduction maintenance, and the occurrence of possible adverse events.
  
  
  RESULTS
  All fractures healed, and radiographic union was observed at an average of 3 months. The average elbow range of motion was 125°, with 125° of flexion and 20 of extension. According to the Broberg and Morrey score, there were four excellent and four good results. Using the Mayo Elbow Performance Index, five cases achieved excellent scores and three reported good results. Adverse events reported in three cases were as follows: heterotopic ossification, complex regional pain syndrome and delayed lateral collateral ligament disruption.
  
  
  CONCLUSIONS
  The use of cannulated compression headless screws has given satisfactory results, allowing a strong inter-fragmentary compression, early mobilization, with high union rates and good elbow function. However, patients should be counseled about the high proportion of adverse events following these injuries.
authors.affiliation: Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy. tarallo.luigi@policlinico.mo.it.
authors.forename: L
authors.initials: L
authors.lastname: Tarallo
authors.affiliation: Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Mugnai
authors.affiliation: Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Adani
authors.affiliation: Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Zambianchi
authors.affiliation: Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
authors.forename: C A
authors.initials: CA
authors.lastname: Costanzini
authors.affiliation: Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Catani
mesh_terms: D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D016896:Treatment Outcome
keywords: Broberg and Morrey; Cannulated screws; Complications; Coronal shear fractures; Distal humerus; Mayo Elbow Performance Index