title: Articular shear injuries of the capitellum in adolescents.
abstract: BACKGROUND
  Fractures of the capitellum are rare and are commonly classified into 4 types. Type II variants involve a shear injury with a mostly articular cartilage component and little subchondral bone. Symptoms upon presentation after these injuries are variable, and the diagnosis can be difficult to make in the immature skeleton.
  
  
  METHODS
  We retrospectively reviewed 3 cases of type II capitellar fractures in adolescent athletes who presented for evaluation with the senior author.
  
  
  RESULTS
  All patients were initially treated conservatively, without identification or treatment of the capitellar shear component of their injury. Unfortunately, radiocapitellar arthrosis rapidly developed in all 3 and required surgical intervention at our institution. At an average postoperative follow-up of 49 months from the index procedure, patients ultimately had positive outcomes despite advanced degenerative changes on imaging. One patient required 2 subsequent operations for mechanical symptoms and pain.
  
  
  CONCLUSIONS
  The 3 reported cases represent adolescent, athletic patients with missed shear injuries to the capitellum. These patients exhibited low Disabilities of Arm, Shoulder and Hand scores and high Mayo Elbow Performance Scores at final follow-up, but each patient demonstrated advanced degenerative changes on imaging, and 1 patient required 2 subsequent operations for mechanical symptoms and pain. A high index of suspicion is necessary to identify this injury pattern, and proper plain radiographic imaging with a low threshold for advanced imaging is necessary. Although the overall long-term prognosis is unknown for these patients, early recognition likely would have changed the initial conservative management decision in each and, theoretically, might have altered the outcome for these patients.
authors.affiliation: Steadman-Philippon Research Institute, Vail, CO, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Frank
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: bryan.m.saltzman@gmail.com.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Saltzman
authors.affiliation: Department of Orthopedic Surgery and Rehabilitation, Loyola University, Maywood, IL, USA.
authors.forename: Nickolas
authors.initials: N
authors.lastname: Garbis
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D018771:Arthralgia / Q000209:etiology / Q000601:surgery; D001265:Athletic Injuries / Q000601:surgery; D002370:Casts, Surgical / Q000009:adverse effects; D002648:Child; D003951:Diagnostic Errors; D004185:Disability Evaluation; D004551:Elbow Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities / Q000009:adverse effects; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D017211:Treatment Failure; D000092464:Elbow Injuries
keywords: Capitellum; Kocher-Lorenz; adolescent; athlete; capitellar; elbow; fracture; type 2