Journal of Shoulder and Elbow Surgery

Biomechanical stability of simple coronal shear fracture fixation of the capitellum

Published:January 30, 2021DOI:


      Coronal shear fractures of the capitellum are rare, and their surgical management is challenging, without a defined gold standard. The purpose of this study was to compare the biomechanical stability of 3 different internal fixation techniques for simple coronal shear fractures of the capitellum without posterior comminution.


      Dubberley type IA fractures of the capitellum were created in 18 cadaveric elbows, which were age and sex matched to the following 3 internal fixation groups: (1) two anteroposterior cannulated headless compression screws (HCSs), (2) two anteroposterior HCSs with an additional anterior antiglide plate (antiGP), and (3) a posterolateral distal humeral locking plate (LP). All fixation techniques were cyclically loaded with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure.


      Fragment displacement under cyclic loading with 2000 cycles did not show a significant difference (P = .886) between the 3 groups. The HCS group showed the highest stiffness compared with the HCS-antiGP and LP groups (602 N/mm vs. 540 N/mm vs. 462 N/mm, P = .417), without reaching a statistically significant difference. Ultimate load to failure was also not significantly different on comparison of all 3 groups (P = .297).


      Simple coronal shear fractures of the capitellum are biomechanically equally stabilized by HCSs compared with HCSs with an additional antiGP or a posterolateral distal humeral LP. In view of the advantages of less (invasive) metalware, the clinical use of 2 isolated anteroposterior HCSs appears reasonable.

      Level of evidence


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        • Alvarez E.
        • Patel M.R.
        • Nimberg G.
        • Pearlman H.S.
        Fracture of the capitulum humeri.
        J Bone Joint Surg Am. 1975; 57: 1093-1096
        • Bryan R.
        • Morrey B.
        Fractures of the distal humerus.
        in: Morrey B. The elbow and its disorders. Saunders, Philadelphia1985: 302-339
        • Dhahbi W.
        • Chaabene H.
        • Chaouachi A.
        • Padulo J.
        • Behm D.G.
        • Cochrane J.
        • et al.
        Kinetic analysis of push-up exercises: a systematic review with practical recommendations.
        Sports Biomech. 2018; : 1-40
        • Dubberley J.H.
        • Faber K.J.
        • Macdermid J.C.
        • Patterson S.D.
        • King G.J.
        Outcome after open reduction and internal fixation of capitellar and trochlear fractures.
        J Bone Joint Surg Am. 2006; 88: 46-54
        • Elkowitz S.J.
        • Polatsch D.B.
        • Egol K.A.
        • Kummer F.J.
        • Koval K.J.
        Capitellum fractures: a biomechanical evaluation of three fixation methods.
        J Orthop Trauma. 2002; 16: 503-506
        • Grantham S.A.
        • Norris T.R.
        • Bush D.C.
        Isolated fracture of the humeral capitellum.
        Clin Orthop Relat Res. 1981; : 262-269
        • Guitton T.G.
        • Doornberg J.N.
        • Raaymakers E.L.
        • Ring D.
        • Kloen P.
        Fractures of the capitellum and trochlea.
        J Bone Joint Surg Am. 2009; 91: 390-397
        • Halls A.A.
        • Travill A.
        Transmission of pressures across the elbow joint.
        Anat Rec. 1964; 150: 243-247
        • Lopiz Y.
        • Rodriguez-Gonzalez A.
        • Garcia-Fernandez C.
        • Marco F.
        Open reduction and internal fixation of coronal fractures of the capitellum in patients older than 65 years.
        J Shoulder Elbow Surg. 2016; 25: 369-375
        • Markolf K.L.
        • Lamey D.
        • Yang S.
        • Meals R.
        • Hotchkiss R.
        Radioulnar load-sharing in the forearm. A study in cadavera.
        J Bone Joint Surg Am. 1998; 80: 879-888
        • Matache B.A.
        • Culliton K.
        • Chang Y.
        • Cron G.O.
        • Louati H.
        • Pollock J.W.
        Lateral trochlear ridge: a non-articulating zone for anterior-to-posterior screw placement in fractures involving the capitellum and trochlea.
        J Bone Joint Surg Am. 2019; 101: e75
        • McKee M.D.
        • Jupiter J.B.
        • Bamberger H.B.
        Coronal shear fractures of the distal end of the humerus.
        J Bone Joint Surg Am. 1996; 78: 49-54
        • Mighell M.
        • Virani N.A.
        • Shannon R.
        • Echols Jr., E.L.
        • Badman B.L.
        • Keating C.J.
        Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws.
        J Shoulder Elbow Surg. 2010; 19: 38-45
        • Morrey B.F.
        • An K.N.
        • Stormont T.J.
        Force transmission through the radial head.
        J Bone Joint Surg Am. 1988; 70: 250-256
        • Oshibe N.
        • Marukawa E.
        • Yoda T.
        • Harada H.
        Degradation and interaction with bone of magnesium alloy WE43 implants: a long-term follow-up in vivo rat tibia study.
        J Biomater Appl. 2019; 33: 1157-1167
        • Ruchelsman D.E.
        • Tejwani N.C.
        • Kwon Y.W.
        • Egol K.A.
        Open reduction and internal fixation of capitellar fractures with headless screws.
        J Bone Joint Surg Am. 2008; 90: 1321-1329
        • Sen M.K.
        • Sama N.
        • Helfet D.L.
        Open reduction and internal fixation of coronal fractures of the capitellum.
        J Hand Surg Am. 2007; 32: 1462-1465
        • Song Z.
        • Wang Q.
        • Ma T.
        • Wang C.
        • Yang N.
        • Xue H.
        • et al.
        Anti-sliding plate technique for coronal shear fractures of the distal humerus.
        J Orthop Surg Res. 2020; 15: 18
        • Tarallo L.
        • Mugnai R.
        • Adani R.
        • Zambianchi F.
        • Costanzini C.A.
        • Catani F.
        Shear fractures of the distal humerus: is the use of intra-articular screws a safe treatment?.
        Musculoskelet Surg. 2015; 99: 217-223
        • Torroni A.
        • Xiang C.
        • Witek L.
        • Rodriguez E.D.
        • Coelho P.G.
        • Gupta N.
        Biocompatibility and degradation properties of WE43 Mg alloys with and without heat treatment: in vivo evaluation and comparison in a cranial bone sheep model.
        J Craniomaxillofac Surg. 2017; 45: 2075-2083
        • Wagner F.C.
        • Post A.
        • Yilmaz T.
        • Maier D.
        • Neubauer J.
        • Feucht M.J.
        • et al.
        Biomechanical comparison of biodegradable magnesium screws and titanium screws for operative stabilization of displaced capitellar fractures.
        J Shoulder Elbow Surg. 2020; 29: 1912-1919
        • Wang P.
        • Kandemir U.
        • Zhang K.
        • Zhang B.
        • Song Z.
        • Huang H.
        • et al.
        Treatment of capitellar and trochlear fractures with posterior comminution: minimum 2-year follow-up.
        J Shoulder Elbow Surg. 2019; 28: 931-938
        • Watts A.C.
        • Morris A.
        • Robinson C.M.
        Fractures of the distal humeral articular surface.
        J Bone Joint Surg Br. 2007; 89: 510-515
        • Yu T.
        • Tao H.
        • Xu F.
        • Hu Y.
        • Zhang C.
        • Zhou G.
        Comparison of lateral approach versus anterolateral approach with Herbert screw fixation for isolated coronal shear fractures of humeral capitellum.
        J Orthop Surg Res. 2019; 14: 230
        • Yu T.
        • Tao H.
        • Xu F.
        • Hu Y.
        • Zhang C.
        • Zhou G.
        Management of isolated coronal shear fractures of the humeral capitellum with Herbert screw fixation through anterolateral approach.
        BMC Musculoskelet Disord. 2018; 19: 108