Abstract: Introduction: The understanding of the anatomical configuration of the fractures of the Capitellum has enhanced in the last few years and the classification of these fractures continues to evolve. It is essential to tailor the surgical approaches to these fractures based on the state of the art classifications.
Materials and methods: 33 patients with fractures of the Capitellum were included in this retrospective study conducted at Bidar Institute of Medical Sciences, Bidar. The mean age of the patients was 37.5 years and the mean follow-up period was 24.6 months. Seventeen patients had Bryan-Morrey type I fracture, three had type II fracture, two had type III fracture and eleven had type IV fracture. Of the 11 patients with Bryan-Morrey type 4 fracture, 5 patients belonged to Dubberley 2A and 3A category and 6 patients belonged to Dubberley 2B and 3B category. Bryan-Morrey type 1 fractures were approached via extended lateral approach. Bryan-Morrey type 2 and type 3 fractures were approached via anterolateral approach. Dubberley 2A and 3A fractures were approached via the anterolateral approach and Dubberley 2B and 3B fractures were approached via the posterior trans-olecranon approach.
Results: Fracture united in all except two patients who showed slight delay in union. Two patients had avascular necrosis of the Capitellum fragment. The mean range of flexion/extension was 135.3°and pronation/supination was 168.8°. The mean Mayo Elbow Performance Index at final follow-up was 92.5 (S.D±5.8).Based on the MEPI score, 14 patients had excellent, 10 patients had good, 6 patients had fair and 3 patients had poor results.
Conclusion: Correct choice of surgical approach facilitates accuracy of reduction and fixation of these difficult fractures. Poor results were seen mainly in fractures belonging to Dubberley type 3B category.
