[Operative treatment of Dubberley type 3B capitulum-trochlea fractures]

Xiaochuan Hu, Ming Xiang, Guoyong Yang, Hang Chen, Haochen Tang
Chinese Journal of Reparative and Reconstructive Surgery 2014, 28 (10): 1194-8

OBJECTIVE: To investigate the method and effectiveness of operative treatment of Dubberley type 3B capitulum-trochlea fractures.

METHODS: Between January 2009 and December 2012, 8 cases of Dubberley type 3B capitulum- trochlea fractures were treated. There were 2 males and 6 females with an average age of 55 years (range, 43-65 years). The injury was caused by falling in 6 cases, electric bicycle accident in 1 case, and traffic accident in 1 case. All fractures were fresh and closed injury. No neural or vascular injury was found. The time between injury and operation was 3-15 days (mean, 5.9 days). Olecranon osteotomy was performed by a posterior midline skin incision of the elbow; 3.0 mm Herbert compression screws placed from posterior to anterior, 2.4 mm L shape locking compression plate designed for distal radius or 2.7 mm anatomical locking compression plate designed for distal humerus and 1.0 mm Kirschner wires or 3.0 mm Herbert screw for the transverse and coronal plane in the subchondral of anterior articular surface were used for fixation; and the lateral and medial collateral ligaments were repaired.

RESULTS: All incisions healed by first intention. The patients were followed up 12-18 months (mean, 14.5 months). The X-ray films showed that fracture healing was achieved at 12-24 weeks (mean, 15 weeks) in 7 cases. Fracture nonunion and partial bone resorption in the capitellum were observed in 1 case. No failure of internal fixation, ulnohumeral joint instability, or traumatic arthritis occurred. At last follow-up, the range of motion of injured elbow was 0-40° in extension (mean 25.0°), 100-135° in flexion (mean, 116.3°), 60-70° in pronation (mean, 61.3°), and 80-90° in supination (mean, 81.3°). The elbow function score was 64-96 (mean, 81.1) according to the Broberg-Morrey evaluation criteria; the results were excellent in 2 cases, good in 4 cases, and fair in 2 cases with an excellent and good rate of 75%. The visual analogue scale (VAS) score was 0-3 (mean, 1).

CONCLUSION: For Dubbelley type 3B capitulum-trochlea fractures, an early anatomic reconstruction of capitellar and trochlea, repair of the medial and lateral collateral ligament, and early active mobilization can obtain good functional

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