Published online Dec 18, 2015. doi: 10.5312/wjo.v6.i11.867
Peer-review started: May 30, 2015
First decision: August 4, 2015
Revised: September 11, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 18, 2015
Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy and imaging advancements, the complex nature of these fractures is well appreciated now. These fractures involve metaphysealcomminution of lateral column and associated intraarticular injuries are common. Previously, closed reduction and excision were the accepted treatment but now preference is for open reduction and internal fixation with an aim to provide stable and congruent joint with early range of motion of joint. Various approaches including extensile lateral, anterolateral and posterior approaches have been described depending on the fracture pattern and complexity. Good to excellent outcome have been reported with internal fixations and poor results are noted in articular comminution with associated articular injuries. Various implants including headleass compression screws, minifragment screws, bioabsorbable implants and column plating are advocated for reconstruction of these complex fractures. Inspite of articular fragments being free of soft tissue attachments the rate of osteonecrosis and osteoarthritis is reported very less after internal fixation. This article summarizes the diagnostic and treatment strategies for these rare fractures and recommendations for management.
Core tip: Coronal shear fractures of the distal humerus are rare, complex fractures. The radiographic evaluation and better understanding by computed tomography helps in the management of these technically challenging fractures. Open reduction and internal fixation by various approaches and implants is advocated. We aim to review the existing diagnostic and treatment protocols with our recommendations for management.