Suresh Ss
Department of Orthopaedics, Ibri Regional Referral Hospital, PO Box 46, Ibri 516, Sultanate of Oman.
Indian J Orthop. 2009 Jul;43(3):286-91. doi: 10.4103/0019-5413.53460.
Fractures of the capitellum are rare injuries of the elbow usually seen in the adolescents. This fracture is often missed in the emergency room if a proper radiograph is not available. Recent reports have described many modalities of treatment favoring headless screw for fixation. The facility for headless screw fixation, however, is not available in most centers. This paper presents the diagnosis and management of type 4 capituller fractures (Mckee) with gadgets available in a district hospital.
Between 2004 and 2007 three patients with right sided type IV capetullar fracture were treated in a district hospital. There were two boys aged 15 and 17 and one 33 years old lady. In one case, the fracture was missed in the emergency room. A double arc sign in the lateral views of the X-rays of the elbow was seen in all the cases. In each case a preoperative CT scan was done and a diagnosis of Mckee type IV fracture of the capitellum was made. Under tourniquet, using extended lateral approach, open reduction and internal fixation was done using 4mm partially threaded AO cancellous screws (n=2) and 2.7 mm AO screws (n=1), under vision from posterior to anterior direction from the posterior aspect of lateral condyle of humerus avoiding articular penetration.
All the fractures united uneventfully. At the end of one year follow-up, two cases had excellent elbow function; implants were removed and there were no signs of AVN or arthritis. The third case had good elbow ROM at 11 months without AVN.
Double arc sign on lateral X-rays of the elbow along with pre-operative CT scan evaluation is important to avoid a missed diagnosis and analysis of type IV capitellur fracture. Fixation with non-cannulated ordinary AO screws using extended Kocher's lateral approach has given good results.
肱骨小头骨折是肘部的罕见损伤，多见于青少年。如果没有合适的X线片，这种骨折在急诊室常被漏诊。最近的报告描述了许多治疗方式，倾向于使用无头螺钉进行固定。然而，大多数中心没有无头螺钉固定设备。本文介绍了在地区医院使用现有器械对4型肱骨小头骨折（麦基分型）的诊断和处理。
2004年至2007年期间，一家地区医院治疗了3例右侧IV型肱骨小头骨折患者。其中有两名男孩，年龄分别为15岁和17岁，还有一名33岁的女性。有1例在急诊室漏诊。所有病例在肘部X线侧位片上均可见双弧征。每例患者均进行了术前CT扫描，诊断为麦基IV型肱骨小头骨折。在止血带下，采用延长外侧入路，从肱骨外侧髁后方由后向前直视下进行切开复位内固定，使用4mm部分螺纹AO松质骨螺钉（2例）和2.7mm AO螺钉（1例），避免穿破关节。
所有骨折均顺利愈合。随访1年时，2例患者肘部功能优良；取出内固定物，无缺血性坏死或关节炎迹象。第3例患者在11个月时肘部活动度良好，无缺血性坏死。
肘部X线侧位片上的双弧征以及术前CT扫描评估对于避免漏诊和分析IV型肱骨小头骨折很重要。采用延长的科赫尔外侧入路，用非空心普通AO螺钉固定取得了良好效果。
