Isolated trochlear shear fracture of the distal humerus: a case report

Authors

  • Saeb Mefleh Mistarihi Department of Orthopaedics, Royal Medical Services, Amman, Jordan
  • Ehab Hamzeh Azam Department of Orthopaedics, Royal Medical Services, Amman, Jordan
  • Naser Fuad Shari Department of Orthopaedics, Royal Medical Services, Amman, Jordan
  • Motaz Mohammad Ali Al Qasaimeh Department of Orthopaedics, Royal Medical Services, Amman, Jordan
  • Mohammad Jumah Hawasheh Department of Orthopaedics, Royal Medical Services, Amman, Jordan

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20222194

Keywords:

Anteromedial elbow approach, Elbow stability, Herbert screws, Humerus, Trochlear fracture

Abstract

Laugier was the first to describe an isolated humeral trochlea fracture in 1853. We report the case of a patient with an isolated fracture of the trochlea and discuss the underlying mechanisms and the clinical, radiological features of this pathology and surgical management of this rare fracture. The elbow arthrotomy was done via an anteromedial approach, with the interval through the flexor-pronator muscles medially and the brachialis muscle laterally. The trochlea was temporally fixed by two Kirschner wires, and the definitive fixation was obtained by two cannulated. Herbert screws from anterior to posterior. The elbow was immobilized and splinted in a flexed position (70 degrees) for two weeks to allow soft tissue healing and minimize pain. After cast removal, rehabilitation of elbow was established and actively assisted mobilization for three months. The isolated trochlea fracture is a rare injury and usually, it is associated with other injuries such as elbow dislocation. Few studies in the literature described such fracture and the anteromedial approach; most of these studies described the use of a direct medial approach to the elbow. Several fixation methods were described in the literature, including k-wires, AO compression screws, and headless compression screws. Isolated fracture of the trochlea is rare. The mechanisms causing this fracture are complex; the usual mechanism of isolated trochlear fractures is falling on the palm with the elbow extended and supinated. In our report, the patient disclosed that he felt directly on his flexed elbow. Trochlear fractures require open reduction and internal fixation to achieve anatomical reduction, with excision of the small osteochondral fragments that may be complicated by arthritic changes.

Author Biographies

Saeb Mefleh Mistarihi, Department of Orthopaedics, Royal Medical Services, Amman, Jordan

Orthopedic depatment - Orthopedic & hand surgery senior specialist

Ehab Hamzeh Azam, Department of Orthopaedics, Royal Medical Services, Amman, Jordan

Orthopedic depatment - Orthopedic & hand surgery specialist

Naser Fuad Shari, Department of Orthopaedics, Royal Medical Services, Amman, Jordan

Orthopedic depatment - Orthopedic surgery specialist

Motaz Mohammad Ali Al Qasaimeh, Department of Orthopaedics, Royal Medical Services, Amman, Jordan

Orthopedic depatment - Orthopedic & hand surgery specialist

Mohammad Jumah Hawasheh, Department of Orthopaedics, Royal Medical Services, Amman, Jordan

Orthopedic depatment - Orthopedic & hand surgery specialist

References

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Published

2022-08-25