Capitellar and Trochlear Fractures Michael J. Carroll, MD, FRCSC, George S. Athwal, MD, FRCSC, Graham J.W. King, MD, MSc, FRCSC, Kenneth J. Faber, MD, MPHE, FRCSC* INTRODUCTION Coronal shear fractures of the distal humerus may involve the capitellum alone; however, most extend medially to include a portion of the trochlea. Isolated fractures of the trochlea have been described but are especially rare. 1 Fractures of the capitellum compose 6% of distal humerus fractures and 1% of all elbow fractures, making them relatively uncommon. 2 Associated bone and soft tissue injuries to the elbow are com- mon 3–9 ; however, clinicians need to be vigilant in their assessment. Lateral collateral ligament (LCL) injury or radial head fracture may be seen in up to approximately 60% of patients with this type of fracture. 3 Open reduction and internal fixation (ORIF) is the favored treatment of most displaced coronal shear fractures of the distal humerus. The evidence to support this, however, is limited to small case se- ries. 3–7,9–15 In addition to ORIF, several other treat- ment options have been described and include closed reduction, 16–18 fragment excision, exci- sion, 8,19,20 and arthroscopic-assisted reduction and internal fixation (AARIF). 21–23 Arthroplasty is indicated when stable internal fixation cannot be achieved for intra-articular distal humerus frac- tures in the elderly 24,25 ; however, its application to coronal shear fractures of the distal humerus is not well studied. The ideal management of these fractures is uncertain as no comparative studies exist and available studies use varying rating Disclosures: Dr G.J.W. King is a consultant for Wright Medical Technologies and receives royalties for implant development. Wright Medical Technologies had no input into this research in any manner. All other authors, their immediate families, or any research foundation with which they are affiliated have not received any financial payment or other benefits from any commercial entity related to the subject of this article. Division of Orthopedic Surgery, RothjMcFarlane Hand & Upper Limb Centre, St. Joseph’s Health Center, West- ern University, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada * Corresponding author. E-mail address: kjfaber@uwo.ca KEYWORDS  Capitellum  Trochlea  Coronal shear  Fracture  Distal humerus KEY POINTS  Capitellum and trochlea fractures are commonly associated with concomitant injuries, such as radial head fracture and lateral ligament instability.  Computed tomography is recommended as plain radiographs often underestimate fracture displacement and comminution.  A single posterior skin incision is preferred as it can be used to for surgical exposure of both the lateral and medial aspects of the elbow.  Anatomic reduction and stable fixation are required for early range of motion. This technique may be accomplished with cannulated standard or headless compression screws, fine-threaded Kirsch- ner wire, bone graft, and/or posterolateral locking plate fixation.  Restricted range of motion or a protective, ligament-specific protocol is used for rehabilitation if sta- ble fixation or joint stability is not achievable. Hand Clin - (2015) -–- http://dx.doi.org/10.1016/j.hcl.2015.07.001 0749-0712/15/$ – see front matter Ó 2015 Elsevier Inc. All rights reserved. hand.theclinics.com