Capitellar Fractures Workup

Updated: Jul 10, 2020
  • Author: Janos P Ertl, MD; Chief Editor: Harris Gellman, MD  more...
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Workup

Imaging Studies

Standard anteroposterior (AP) and lateral radiographic projections should be obtained. In most instances, these will demonstrate the fracture. In type II fractures, a radial head–capitellum view may be useful in assisting in subchondral bone visualization. Radiographs of the shoulder or wrist should be obtained if the patient has any complaints of pain or tenderness on examination. Capitellar fractures may be associated with radial head fractures and posterior dislocation of the elbow.

Linear tomography and computed tomography (CT) sometimes may be necessary to achieve better delineation of the fracture pattern and the amount of subchondral bone present.

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Classification

Capitellar fractures have been conventionally classified as types I and II, but a more extensive and descriptive classification system, the Bryan and Morrey system, [11]  has also been developed and is now in common use.

The conventional classification includes the following types:

  • Type I (Hahn-Steinthal fracture) - Complete fracture with a large osteochondral fragment that is equivalent to the entire capitellum
  • Type II (Kocher-Lorenz fracture) - Thinner, more superficial layer of subchondral bone with attached cartilage; rarely, a complete-thickness, chondral-shearing fragment is present and may be difficult to identify on radiographs
  • Type III - Comminuted capitellar fracture

The Bryan and Morrey classification system includes the following types [11] :

  • Type I - Complete osteochondral fracture of the capitellum
  • Type II - Superficial osteochondral fracture fragment
  • Type III - Comminuted fracture fragment
  • Type IV - Coronal shear fracture described by McKee et al, involving the capitellum and a portion of the trochlea [6, 10]

Another classification, the Dubberley system, stratifies these injuries into three types, each of which has A and B subtypes, as follows [12] :

  • Type 1 - Fracture of capitellum with or without lateral trochlear ridge: (A) without posterior condylar comminution; (B) with posterior condylar comminution
  • Type 2 - Fracture of capitellum and trochlea as one piece: (A) without posterior condylar comminution; (B) with posterior condylar comminution
  • Type 3 - Fracture of capitellum and trochlea as separate pieces: (A) without posterior condylar comminution; (B) with posterior condylar comminution
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