Management and outcomes of capitellum fractures in adolescents: A case series and review of the literature.

INTRODUCTION AND IMPORTANCE

Shear capitellum fractures (CFs) are rare, particularly in pediatric populations, and pose significant diagnostic challenges due to the high cartilaginous content of the developing elbow. These injuries often involve small osteochondral fragments that may escape detection on standard radiographs, requiring a high index of clinical suspicion. Timely and appropriate surgical management is crucial to prevent long-term complications. This case series presents the outcomes of four adolescents with displaced CFs treated by ORIF using Kirschner wires (K-wires) in three cases and a spongy screws in one case, highlighting the reliability of K-wires fixation, especially in resource-limited settings.

CASE PRESENTATION

We retrospectively reviewed four adolescents (3 boys, 1 girl; mean age: 13.5 years) treated for displaced CFs at our Pediatric Emergency Department between 2019 and 2024. Three injuries followed falls on an extended elbow and one on a flexed elbow. One case was associated with an ipsilateral elbow dislocation. Fractures were classified as Type I (two cases) and Type IV (two cases). ORIF was performed using K-wires (three cases) or a spongy screw (one case) via lateral (two cases) or posterolateral (two cases) approaches. Postoperative care included four weeks of immobilization in 90° flexion using a posterior brachio-antebrachial (BAB) splint, followed by progressive mobilization and physiotherapy in two cases. At a mean follow-up of 18 months (range: 12-24), all patients achieved bone union within 6-8 weeks. K-wires were removed at six weeks and the screw at six months. Full pronation and flexion were regained, with only minor residual limitations in extension and supination in two patients. Functional outcomes were excellent, with a mean MEPI score of 100. No complications were observed, and all patients and their families expressed satisfaction with the results.

CLINICAL DISCUSSION

CFs in adolescents are uncommon and frequently overlooked due to subtle radiological findings. When clinical suspicion is high, advanced imaging such as CT is invaluable for accurate diagnosis. ORIF via lateral or posterolateral approaches using K-wires or screws provides stable anatomical reduction and preserves joint function. K-wires fixation remains a practical and effective option, particularly in low-resource settings.

CONCLUSION

Early diagnosis and surgical management are essential in treating displaced CFs in adolescents. This series supports the effectiveness of K-wires fixation in restoring joint integrity and achieving excellent functional outcomes, underscoring its value in resource-constrained environments.