Isolated Fracture of Distal Humeral Trochlea

Ki-Won Lee; Joo-Yul Bae; Hyung-Kwon Cho; Hee-Jae Won

doi:10.12790/jkssh.2016.21.3.152

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Lee, Bae, Cho, and Won: Isolated Fracture of Distal Humeral Trochlea

CASE REPORT

J Korean Soc Surg Hand 2016;21(3):152-156.

Published online: 11 September 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.3.152

Isolated Fracture of Distal Humeral Trochlea

Ki-Won Lee, Joo-Yul Bae, Hyung-Kwon Cho, Hee-Jae Won

Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea

Correspondence to: Joo-Yul Bae, Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Gangneung 25440, Korea, TEL: +82-33-610-3249, FAX: +82-33-641-8050, E-mail: qwonduf@hanmail.net

Received 2 March 201611 July 2016 Accepted 12 July 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Isolated fracture of the distal humeral trochlea occurs while the axial load delivered to the elbow passes through the trochlear of the distal humerus. It has been rarely reported, because of those reasons. The trochlea is located deep inside of the elbow joint space and since it does not have the direct attachment with muscles or ligaments, a force is hardly transmitted directly. Also ulno-humeral joint is less influenced by compressive or shear force than radio-humeral joint. We report a case of isolated trochlear fracture with review of the literature.

Keywords: Humerus, Trochlea, Fracture

REFERENCES

1. Foulk DA, Robertson PA, Timmerman LA. Fracture of the trochlea. J Orthop Trauma. 1995; 9:530–2.

2. Sen RK, Tripahty SK, Goyal T, Aggarwal S. Coronal shear fracture of the humeral trochlea. J Orthop Surg (Hong Kong). 2013; 21:82–6.

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8. Worrell RV. Isolated, displaced fracture of the trochlea. N Y State J Med. 1971; 71:2314–5.

9. Goncalves LB, Ring DC. Fractures of the humeral trochlea: case presentations and review. J Shoulder Elbow Surg. 2016; 25:e151–5.

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Fig. 1.

Initial radiograph.

Fig. 2.

(A, B) Initial computed tomography scan.

Fig. 3.

(A, B) Postoperative radiograph and sagittal plane views of computed tomography scan shows open reduction and internal fixation with cancellous screw.

Fig. 4.

Radiograph after implant removal.

Table 1.

Reports of isolated trochlear fracture

Reference	Sex/age (yr)	Side	Elbow position	Approach	Fixation	Direction of fixation	Final ROM
Worrell⁸	Female/33	Lt	Extension	Medial	K-wire	ML	10-120
Foulk et al.¹	Female/22	Lt	Flexion	Medial	2 4.0 mm Screw	ML	0-135
Park et al.⁴	Male/17	Lt	-	Anterior	2 Acutrak	ML	0-135
Kwan et al.⁵	Male/32	Rt	Flexion	Medial	2 K-wlre, 1 Herbert	ML/AP	5-135
	Male/24	Lt	Flexion	Medial	Herbert	ML	0-135
Sen et al.²	Male/29-46	-	Flexion	Medial	4.0 mm screws, K-wires	ML	5-125 to 20-120
	Female/25	-	Flexion	Medial	4.0 mm screws	-	10-115
Lechasseur et al.⁷	Female/49	Rt	-	Lateral	3 Mini screw	LM	90-105
Abbassi et al.³	Male/21	Rt	Extension	Medial	2 Herbert	AP	0-150
Goncalves and Ring⁹	Female/66	Lt	Flexion	Posterior transolecranon	2 4.0 mm full thread screws	LM	30-120
	Male/53	Rt	Flexion	Medial	2 4.0 mm screws, 1 Herbert	ML/AP	10-130
Gomati et al.⁶	Male/23	Lt	Extension	Posterior transolecranon	3 Herbert	PA	0-130

ROM, range of motion Lt, left; ML, medial to lateral; Rt, right; AP, anterior to posterior; LM, lateral to medial; PA, posterior to anterior.

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