Coronal shear fractures of the distal humerus managed according to the Modified Dubberley Classification System

• Published in: Journal of shoulder and elbow surgery Vol. 31; no. 1; pp. 133 - 142
• Main Authors: Shergold, Sophie, Derias, Mina, Moverley, Robert, Murphy, Richard J., Guryel, Enis, Phadnis, Joideep
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2022
• Subjects: Bone Plates; Coronal shear fracture; distal humerus; elbow; Elbow Joint - diagnostic imaging; Elbow Joint - surgery; Fracture Fixation, Internal; Humans; Humeral Fractures - diagnostic imaging; Humeral Fractures - surgery; Humerus; modified Dubberley classification; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Coronal shear fracture; Treatment Study; elbow; modified Dubberley classification; distal humerus; Retrospective Cohort Comparison; Level III
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2021.07.002

Coronal shear fractures of the capitellum and trochlea are relatively uncommon and can be challenging to treat because of variable articular comminution and poor bone stock. Classification is valuable to help guide surgical decision making and prognosis. The aim of this study was to present a large series of coronal shear fractures treated according to the Modified Dubberley Classification System (MDCS). Forty-five patients with a coronal shear fracture were followed up (12-93 months, mean: 28 months) after surgical intervention. Fractures were classified according to the MDCS by 3 observers, and outcome data collected included Oxford elbow score (OES), visual analog pain score (VAS), range of motion, complications, and radiographic findings. There were 10 type 1, 12 type 2, 8 type 3, and 15 type 4 fractures. There were 26 subtype B fractures (posterior comminution). A total of 37 patients underwent open reduction and internal fixation (ORIF) and 8 primary arthroplasty. The median OES and VAS were 43(16-48) and 2 (0-9), respectively. Median flexion extension arc was 125° (range, 70°-140°). There was no significant difference in OES, VAS, or range of motion according to fracture type (types 1-4), subtype (type a or b), or treatment method (arthroplasty vs. ORIF). The overall complication and reoperation rates were 31% and 33%, respectively. A total of 75% of complications occurred in type 3 and 4 fractures, and there was a nonsignificant trend toward higher complication rate in type B fractures than type A fractures (34% vs. 16%, P = .19). Patients with a type B fracture who underwent screw-only fixation had a significantly lower OES and higher complication rate compared with when they had combined plating with screws (OES, P = .03; complications P = .04) and compared with when an arthroplasty was performed (OES, P = .05; complications P = .04). Consistently good outcomes can be achieved by classification and management according to the MDCS. It is recommended that type B fractures undergo combined plate and screw fixation and that type 4 fractures should be considered for arthroplasty because of the higher risk of complications with ORIF.