Effects of Trochlear Fragmentation on Functional Outcome in Coronal Shear Fractures: A retrospective comparative study

Abstract Background Coronal shear fractures of the distal humerus are rare injuries, and fragmentation of the capitellum and trochlea with posterior comminution are challenging for surgeons. We retrospectively evaluated the functional outcomes of patients with coronal shear fractures managed with open reduction and internal fixation, focusing on the number of trochlea fragments in Dubberley type 3B fractures. Materials and methods The functional outcomes of 25 patients, including 8 patients with type 3B fractures, with a mean age (and standard deviation) of 57 ± 20 years, were evaluated at a mean follow-up duration of 15 ± 9 months. Type 3B fractures were classified into two groups: those with two trochlea fragments or less group (group A) and those with three or more fragments (group B). Patient outcomes were assessed with clinical and radiographic examination, range-of-motion, and the Mayo Elbow Performance Scale (MEPS). Results Two patients with Type 3B in group B experienced nonunion, and two patients with Type 3B in group A and one with Type 1B demonstrated avascular necrosis on radiographs. The average MEPS score was 96.3 points (range, 70–100), with 18 excellent, 5 good, and 1 fair results. The average range of motion was 10 ± 8 to 130 ± 12. The MEPS score worsened as Dubberley classification progressed from Type 1 to Type 3 (98.3 vs 96.7 vs 88, p=0.014) and subtypes A to B (97.9 vs 90, p=0.014), respectively. In comparing groups A and B, the MEPS score was significantly worse in group B (93.8 vs. 76.3, P=0.006). Conclusion Our ORIF results were largely good, although functional outcomes were diminished as Dubberley classification progressed from Type 1 to Type 3 and subtype A to B. Type 3B fractures with three trochlea fragments or more in the elderly were the most difficult to treat with ORIF and possibly one-term total elbow arthroplasty.