Advances in Management of Pediatric Capitellum Fractures: A Retrospective study

Jasim Hasan Imarah ^1*

This study showed the effectiveness of ORIF in treating rare pediatric capitellum fractures, emphasizing early intervention for optimal outcomes.

Abstract

Background: Capitellum fractures are rare in the pediatric population, with most documented cases occurring in individuals over 12 years old. These fractures present unique challenges in diagnosis and treatment due to the rarity and complexity of pediatric bone healing. The limited literature on this subject often emphasizes adult treatment protocols, leaving gaps in understanding pediatric cases. This study investigates the outcomes of six children, aged 12 to 16, with displaced capitellum fractures treated with open reduction and internal fixation (ORIF). Methods: Between 2000 and 2020, six pediatric patients with displaced capitellum fractures were treated at AL-Hussain Teaching Hospital. All fractures were classified as type 1 Hahn-Steinthal fractures and were managed using ORIF with screw fixation. Postoperatively, patients were immobilized for three weeks and followed up clinically and radiologically for 20 months to 4 years to assess pain, range of motion, and any complications. Results: All patients achieved solid fracture union with no cases of avascular necrosis, heterotopic ossification, or infection. Following cast removal, patients initially experienced stiffness but ultimately regained full elbow function, with only two patients experiencing minor flexion loss. There were no radiological signs of degenerative changes or deformities. Conclusion: ORIF using screw fixation is effective in managing displaced capitellum fractures in pediatric patients, resulting in solid union and good functional outcomes. Early intervention and careful postoperative management are crucial in minimizing complications. However, the rarity of these injuries underscores the need for further research to establish standardized treatment protocols.

Keywords: Pediatric fractures, capitellum, open reduction, internal fixation, elbow injuries, bone healing, orthopedic surgery

References

Acharya, S., Kneife, F., & Mackinnon, J. G. (1996). Bilateral fractures of the capitulum: A case report. International Orthopaedics, 20(6), 337-338.

Drvaric, D. M., & Rooks, M. D. (1990). Anterior sleeve fracture of the capitellum. Journal of Orthopaedic Trauma, 4(2), 188-192.

Drvaric, D. M., & Rooks, M. D. (1990). Anterior sleeve fracture of the capitellum. Journal of Orthopaedic Trauma, 4(2), 188-192.

Fowles, J. V., & Kassab, M. T. (1974). Fracture of the capitulum humeri, treatment by excision. The Journal of Bone and Joint Surgery, 56(5), 794-798.

Grantham, S. A., Norris, T. R., & Bush, D. C. (1981). Isolated fracture of the humeral capitellum. Clinical Orthopaedics and Related Research, 161, 262-269.

Hirvensalo, E., Bostman, O., Partio, E., Tormala, P., & Rokkanen, P. (1993). Fracture of the humeral capitellum fixed with absorbable polyglycolide pins. Acta Orthopaedica Scandinavica, 64(2), 85-86.

Johansson, J., & Rosman, M. (1980). Fracture of the capitulum humeri in children: A rare injury, often misdiagnosed. Clinical Orthopaedics and Related Research, 146, 157-160.

Letts, M., Rumball, K., Bauermeister, S., McIntyre, W. D., & Astous, J. (1997). Fractures of the capitellum in adolescents. Journal of Pediatric Orthopedics, 17(3), 315-320.

Letts, M., Rumball, K., Bauermeister, S., McIntyre, W. D., & Astous, J. (1997). Fractures of the capitellum in adolescents. Journal of Pediatric Orthopaedics, 17(3), 315-320.

Mehdian, H., & McKee, M. D. (2000). Fractures of the capitellum and trochlea. Orthopedic Clinics of North America, 31(1), 115-127.

Mehdian, H., & McKee, M. D. (2000). Fractures of the capitellum and trochlea. Orthopedic Clinics of North America, 31(1), 115-127.

Poynton, A. R., Kelly, I. P., & O’Rourke, S. K. (1998). Fractures of the capitellum: A comparison of two fixation methods. Injury, 29(5), 341-343.

Salter, R. B., & Harris, W. R. (1963). Injuries involving the epiphyseal plate. The Journal of Bone and Joint Surgery. American Volume, 45(3), 587-632.

Salter, R. B., & Harris, W. R. (1963). Injuries involving the epiphyseal plate. The Journal of Bone and Joint Surgery, 45(4), 587-632.

Scapinelli, R. (1990). Treatment of fractures of the humeral capitellum using fibrin sealant. Archives of Orthopaedic and Trauma Surgery, 109(4), 235-237.

Simpson, L. A., & Richards, R. R. (1986). Internal fixation of a capitellar fracture using Herbert screws: A case report. Clinical Orthopaedics and Related Research, 209, 166-168.

Simpson, L. A., & Richards, R. R. (1986). Internal fixation of a capitellar fracture using Herbert screws: A case report. Clinical Orthopaedics and Related Research, 209, 166-168.

Wood, G. W., & Tullos, H. I. S. (1997). Elbow instability and medial epicondyle fractures. American Journal of Sports Medicine, 5(1), 23-29.