Clinical outcomes and radiographic correlations with fracture complexity in isolated capitellum fractures: A retrospective cohort study.

BACKGROUND

Isolated capitellum fractures, though rare, significantly impact elbow function and are often associated with falls on an outstretched hand (FOOSH). This study aims to evaluate the relationship between forearm radiological parameters and fracture complexity, as well as assess clinical outcomes in patients with isolated capitellum fractures.

METHODS

A retrospective cohort analysis was conducted on 28 fractures in 27 patients treated surgically at a tertiary center. Fractures were classified using the Bryan-Morrey system, and forearm parameters (maximum radial bow, location of maximum radial bow, Proximal Ulna Dorsal Angulation 'PUDA', and Proximal Ulna Varus Angulation 'PUVA') were measured. Clinical outcomes were assessed using Mayo Elbow Performance Score (MEPS) and Quick-DASH scores.

RESULTS

Complex fractures (Bryan-Morrey Types 3 and 4) were associated with worse functional outcomes (p<0.05). A significant correlation was found between the distal location of the maximum radial bow and fracture complexity (p=0.0468). Union was achieved in 86.9% of osteosynthesis cases, with AVN and heterotopic ossification observed in some patients.

CONCLUSION

Fracture complexity correlates with poorer functional outcomes. The distal location of the maximum radial bow may influence fracture patterns, suggesting a biomechanical role in energy transfer during FOOSH injuries. Surgical fixation yields favorable outcomes in especially Bryan-Morrey 1-2 group of patients.