Abstract

FONTOURA, Ugo et al. Fratura de Hahn-Steinthal: A propósito de um caso clínico. Rev. Port. Ortop. Traum. [online]. 2017, vol.25, n.1, pp.35-41. ISSN 1646-2122.

Isolated capitellum fractures are rare lesions and represent less than 1% of all elbow fractures and 6% of the humerus fractures. Usually, this fracture occurs in adolescents under the age of 12. This fracture´s pattern was first described by Hahn in 1853; later, Kocher in 1896, Steinthal in 1898 and Lorenz in 1905 described different types of this fracture. In 1985, Bryan and Morrey classified the capitellum fractures in three types (types I, II and III). In 1996, this classification was updated by McKee with the introduction of a fourth type. Case Report: 24 year-old caucasian woman, with no relevant personal history, presented to the emergency room with pain and functional disability of the right elbow after having fallen from the bicycle with the wrist and elbow in extension. The radiography and CT of the right elbow showed a capitellum fracture. Surgical treatment was the option with open reduction and internal fixation with a cannulated headless compression screw (HCS ® 2,4mm inserted from posterior to anterior by posterolateral Kocher approach). Initially immobilized with posterior cast for 3 weeks, she began rehabilitation with progressive gain of mobility. Conclusion: Different therapeutic options are presented: conservative treatment (closed reduction and immobilization), excision of the fragment or open reduction and internal fixation. Internal fixation is variable: Kirschner wires, reabsorbable pins or different kind of screws in compression. Arthroscopy has also been used to aid surgery. Open reduction and stable internal fixation with cannulated headless compression screw enable early mobilization of the elbow and reduce joint stiffness and subsequent degenerative arthrosis.

Keywords : Capitellum; fracture; Hahn Steinthal; open reduction; internal fixation; cannulated headless compression screw; HCS.

        · abstract in Portuguese     · text in Portuguese     · Portuguese ( pdf )