title: The limited anterior approach of the elbow for open reduction and internal fixation of capitellum fractures. Surgical technique and clinical experience in 2 cases with more than 2 years follow-up.
abstract: OBJECTIVE
  Fractures involving the capitellum can be treated surgically by excision of the fragment, or by reduction and internal fixation with screws, with or without heads. The lateral Kocher approach is the most common approach for open reduction. We believe that the limited anterior approach of the elbow, could be a valid technique for treating these fractures, as it does not involve the detachment of any muscle group or ligament, facilitating the recovery process.
  
  
  METHODS
  A description is presented of the surgical technique, as well as of 2cases with a Bryan-Morrey type 1 fracture (Dubberley type 1A). Two different final quality of life evaluation questionnaires were completed by telephone: the EuroQol Five Dimensions Questionnaire (EQ-5D), and the patient part of the Liverpool Elbow Score (PAQ-LES) questionnaire.
  
  
  RESULTS
  The 2patients showed favourable clinical progress at 36 and 24 months, respectively, with an extension/flexion movement arc of -5°/145° and -10°/145°, as well as a pronosupination of 85°/80° and 90°/90°. The 2patients showed radiological consolidation with no signs of osteonecrosis. The EQ-5D score was 0.857 and 0.910 (range: 0.36-1), and a PAQ-SLE of 35 and 35 (range: 17-36), respectively.
  
  
  CONCLUSIONS
  We believe that the limited anterior approach of the elbow is a technical option to consider for the open surgical treatment of a capitellum fracture, although further studies are needed to demonstrate its superiority and clinical safety compared to the classical lateral Kocher approach.
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España; Departamento Anatomía Humana y Embriología, Facultad de Medicina. Universidad de Barcelona, Barcelona, España. Electronic address: jrballes@clinic.ub.es.
authors.forename: J R
authors.initials: JR
authors.lastname: Ballesteros-Betancourt
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Fernández-Valencia
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España.
authors.forename: R
authors.initials: R
authors.lastname: García-Tarriño
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Domingo-Trepat
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España.
authors.forename: S
authors.initials: S
authors.lastname: Sastre-Solsona
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Combalia-Aleu
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico de Barcelona, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Llusá-Pérez
mesh_terms: D000368:Aged; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D057072:Intra-Articular Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction / Q000379:methods*; D000092464:Elbow Injuries
keywords: Abordaje anterior de codo; Abordaje de Kocher; Abordaje lateral de codo; Anterior approach of the elbow; Capitellum fracture; Fractura de capitellum; Kocher approach; Lateral exposure of the elbow; Nervio radial; Open reduction and internal fixation; Radial nerve; Reducción abierta y fijación interna