title: Open reduction and internal fixation of capitellar fracture through anterolateral approach with headless double-threaded compression screws: a series of 16 patients.
abstract: BACKGROUND
  Fracture of the capitellum is an often missed or inadequately treated serious elbow injury. Anatomic reduction and proper stabilization are essential to obtain articular congruity so that late-onset arthritis can be avoided. The main areas of interest in this intriguing fracture are the choice of implant and the surgical approach. We describe the use of anterolateral approach and headless double-threaded compression screws for the fixation of this fracture.
  
  
  METHODS
  This prospective study included 16 capitellar fractures. A computed tomography scan was done for delineating the fracture line and planning the fixation technique. All fractures were treated with headless double-threaded compression screws using an anterolateral approach, over a period of 3 years, with a mean follow-up of 2.3 years (range, 1.5-4 years).
  
  
  RESULTS
  The average time to bony union was 3.5 months (range, 2.5-5 months) with no malunion or nonunion. The mean range of flexion was 132° (range, 125°-135°). The average extensor lag was 10° (range, 0°-25°), but the range of motion remained functional in all patients. On the final follow-up, no evidence of osteonecrosis, post-traumatic osteoarthritis, or heterotrophic ossification was seen. The outcome was excellent in 10 patients, and 6 patients had a good result.
  
  
  CONCLUSIONS
  The success of management of a capitellar fracture depends on an early diagnosis by keeping a high index of suspicion and timely management. Adequate exposure of the fracture is of paramount importance to achieve accurate reduction. This can be satisfactorily achieved by an anterolateral approach to the elbow. An adequate fixation of the fractured fragments can be achieved by the use of headless double-threaded compression screws.
authors.affiliation: Joint Replacement & Arthroscopy, Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Raju
authors.initials: R
authors.lastname: Vaishya
authors.affiliation: Joint Replacement & Arthroscopy, Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India. Electronic address: dr_vipulvijay@yahoo.com.
authors.forename: Vipul
authors.initials: V
authors.lastname: Vijay
authors.affiliation: Joint Replacement & Arthroscopy, Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Gyanendra Kumar
authors.initials: GK
authors.lastname: Jha
authors.affiliation: Joint Replacement & Arthroscopy, Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Agarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; 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*; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Capitellum; anterolateral approach; fracture; headless double-threaded compression screw; internal fixation; open reduction; outcome