Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2015; 6(11): 867-876
Published online Dec 18, 2015. doi: 10.5312/wjo.v6.i11.867
Coronal shear fractures of distal humerus: Diagnostic and treatment protocols
Ajay Pal Singh, Arun Pal Singh
Ajay Pal Singh, Punjab Civil Medical Services-1, Mukerian 144221, Punjab, India
Arun Pal Singh, Kanwar Hospital, Hajipur 144221, Punjab, India
Author contributions: Singh AP wrote the manuscript; Singh AP edited the manuscript and images.
Conflict-of-interest statement: The authors of the manuscript did not receive funding, grants, or in-kind support in support of the research or the preparation of the manuscript. The authors do not have any association or financial involvement with any organization or commercial entity having a financial interest in or financial conflict with the subject matter or research presented in the manuscript. All authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ajay Pal Singh, Consultant Orthopaedic Surgeon, Punjab Civil Medical Services-1, Mukerian 144221, Punjab, India. docajaypal@gmail.com
Telephone: +91-98-72069734 Fax: +91-01-883244940
Received: May 27, 2015
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.

Keywords: Capitellum, Trochlea, Elbow, Fracture, Distal humerus, Treatment

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.