Avascular necrosis of the capitellum after surgical treatment of a coronal shear fracture of the distal humerus: A case report

Coronal shear fractures of the distal humerus are rare and are expected to have a high incidence of avascular necrosis (AVN) due to the avascular nature of the capitellar bone fragment and limited soft tissue attachment. However, according to the literature published thus far, AVN is infrequently re...

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Bibliographic Details
Published in:International journal of surgery case reports 2023-04, Vol.105, p.108045, Article 108045
Main Authors: Choi, Sung, Han, Jae Hwi, Shin, Dong Ju, Jo, Seong Woo
Format: Article
Language:English
Subjects:
Avascular necrosis of bone
Capitellum
Case Report
Elbow joints
Humerus
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Summary:Coronal shear fractures of the distal humerus are rare and are expected to have a high incidence of avascular necrosis (AVN) due to the avascular nature of the capitellar bone fragment and limited soft tissue attachment. However, according to the literature published thus far, AVN is infrequently reported, and some studies suggest that it does not have a significant impact on clinical outcomes. Two female patients, one aged 72 and the other 70, presented with coronal shear fractures of distal humerus. Both patients were diagnosed with AVN of the capitellum 7 and 10 months after undergoing open reduction and internal fixation. One patient underwent hardware removal, while the other patient declined due to the absence of discomfort. However, at their final follow-up, both patients exhibited good clinical results. The occurrence of AVN may be related to the severity of the initial injury, including posterior comminution. While some studies suggest that AVN of the capitellum may not affect clinical outcomes, hardware removal may be required in cases where there is intra-articular protrusion of the hardware. Although AVN is a rare occurrence, even when it does occur, it may not significantly affect clinical outcomes. In this study, AVN may be associated with initial injury severity, and surgical treatment may make it possible to develop AVN. Moreover, considering the timing of the occurrence of AVN, it is believed that a close follow-up of more than one year will be required. •Although AVN of the capitellum is a known complication of coronal shear fracture, its incidence and timing are poorly documented due to its rarity.•If AVN does not progress to the trochlea, it may does not have a significant impact on clinical outcomes.•Hardware removal surgery may be required in cases where there is intra-articular protrusion of the hardware due to AVN•Since the incidence of AVN in this study occurred within one year, a close follow-up of more than one year is necessary
ISSN:2210-2612
2210-2612
DOI:10.1016/j.ijscr.2023.108045