72.13 Fracture of the capitulum (adults)

In this rare fracture a piece of the patient’s capitulum breaks off, tilts, and moves anteriorly. Unless it is reduced, he will have very little use in his elbow. The fragment varies in size from a small piece of cartilage, to the whole of the front of the patient’s capitulum and part of his trochlea. The head of his radius may be fractured at the same time.

The patient holds his slightly swollen elbow at 90, the contour of his arm is normal, and tenderness is difficult to locate. Rotation is fair, but very little flexion is possible. Small fragments consisting only of cartilage are difficult to see on the X–ray, so diagnose them from the history of locking and the signs of a loose body in the joint.

FRACTURE OF THE CAPITULUM

If the fragment is small, refer the patient for open removal.

If the fragment is large, try to reduce it.

Ask an assistant to exert traction on the patient’s extended forearm. While he does this, press the fragment down firmly with your thumbs. Then when the fragment is in place, flex the patient’s elbow to more than 90.

If closed reduction is successful, apply a collar and cuff for a few weeks and start shoulder and finger exercises immediately.

If X–rays show that reduction has failed, refer him for external fixation of the fragment.