title: Posterior fixation of type IV humeral capitellum fractures with fully threaded screws in adolescents.
abstract: OBJECTIVE
  Humeral capitellum fractures comprise approximately 1% of all elbow fractures. In this study, we examined the clinical, radiographic, and functional outcomes following operative stabilization of Bryan and Morrey type IV fractures of the capitellum in adolescents. We applied headless cannulated screws in a posteroanterior direction without damaging the articular cartilage surface of the fractures.
  
  
  METHODS
  Eight adolescent patients (six male, two female) with a mean age of 15 ± 2.1 years (range 13-18 years) were treated for type IV (McKee) humerus capitellum fractures. In the preoperative radiological evaluation, anteroposterior and lateral radiographs and computed tomography (CT) images were performed. A lateral surgical approach was used, and cannulated fully threaded headless screws were applied in a posteroanterior direction as fixation materials in the fracture reduction. The Mayo Elbow Performance Score was used in the evaluation of elbow joint functions.
  
  
  RESULTS
  Patients were followed up for a mean of 24.6 months. Fracture union was achieved at a mean of 5 ± 0.92 weeks (range 4-6 weeks). The mean elbow extension flexion arc was 135° ± 13.47° (range 110°-150º) and the mean pronation supination arc was 156° ± 4.43° (150°-160°). In one patient, there was nonconformity in the humerus trochlea and in another patient, there was keloid formation on the surgical scar. All patients attained excellent results according to the Mayo Elbow Performance Score.
  
  
  CONCLUSIONS
  In the treatment of type IV capitellum fractures in adolescents, open reduction with a lateral surgical approach and fixation using posteroanterior directed, cannulated, fully threaded, headless screws is a reliable method to achieve a pain-free functional elbow joint.
authors.affiliation: Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey. drtuhan@hotmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Kurtulmus
authors.affiliation: Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey.
authors.forename: N
authors.initials: N
authors.lastname: Saglam
authors.affiliation: Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Saka
authors.affiliation: Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey.
authors.forename: C C
authors.initials: CC
authors.lastname: Avci
authors.affiliation: Faculty of Medicine, Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Kucukdurmaz
authors.affiliation: Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Akpinar
keywords: Capitellum; Coronal shear fracture; Internal fixation; Screw placement
references.citation: Acta Orthop Scand. 1993 Feb;64(1):85-6
references.pmid: 8451957
references.citation: J Hand Surg Am. 2007 Nov;32(9):1462-5
references.pmid: 17996785
references.citation: J Shoulder Elbow Surg. 2010 Jan;19(1):38-45
references.pmid: 19664940
references.citation: J Am Acad Orthop Surg. 2008 Dec;16(12):716-28
references.pmid: 19056920
references.citation: J Orthop Trauma. 2002 Aug;16(7):503-6
references.pmid: 12172281
references.citation: Arthroscopy. 2002 Apr;18(4):422-6
references.pmid: 11951202
references.citation: Injury. 1998 Jun;29(5):341-3
references.pmid: 9813675
references.citation: Injury. 2000 Apr;31(3):204-6
references.pmid: 10704588
references.citation: J Hand Surg Am. 2007 May-Jun;32(5):642-6
references.pmid: 17482002
references.citation: J Bone Joint Surg Am. 1996 Jan;78(1):49-54
references.pmid: 8550679
references.citation: J Trauma. 1996 Feb;40(2):199-203
references.pmid: 8637066
references.citation: J Hand Surg Am. 2009 Apr;34(4):739-44
references.pmid: 19345881
references.citation: J Bone Joint Surg Am. 2006 Jan;88(1):46-54
references.pmid: 16391249
references.citation: J Bone Joint Surg Am. 2003 Feb;85-A(2):232-8
references.pmid: 12571299
references.citation: Clin Orthop Relat Res. 2001 Mar;(384):232-6
references.pmid: 11249170
references.citation: Bull Hosp Jt Dis. 2003;61(3-4):123-6
references.pmid: 15156810
references.citation: Orthop Clin North Am. 2000 Jan;31(1):115-27
references.pmid: 10629337
references.citation: J Shoulder Elbow Surg. 2012 Nov;21(11):1613-22
references.pmid: 22694882
references.citation: Orthopedics. 2002 Jul;25(7):765-6
references.pmid: 12138966
references.citation: J Pediatr Orthop. 1997 May-Jun;17 (3):315-20
references.pmid: 9150018
references.citation: Clin Orthop Relat Res. 1981 Nov-Dec;(161):262-9
references.pmid: 7307389
references.citation: J Shoulder Elbow Surg. 2012 Aug;21(8):1024-1031.e4
references.pmid: 21816633
references.citation: J Orthop Trauma. 2003 Apr;17 (4):279-84
references.pmid: 12679688
references.citation: J Bone Joint Surg Am. 2008 Jun;90(6):1321-9
references.pmid: 18519327
references.citation: J Bone Joint Surg Am. 2009 Feb;91(2):390-7
references.pmid: 19181983
references.citation: J Shoulder Elbow Surg. 2001 Nov-Dec;10 (6):554-6
references.pmid: 11743535
references.citation: J Shoulder Elbow Surg. 2010 Jul;19(5):670-80
references.pmid: 20421172
references.citation: Ital J Orthop Traumatol. 1989 Sep;15(3):295-302
references.pmid: 2599849
references.citation: Acta Orthop. 2010 Apr;81(2):228-33
references.pmid: 20180722