Choice of treatments of the coronal shear fractures of the humerus. A national survey of Italian AO members

Published:November 09, 2022DOI:



      Coronal shear fractures of the distal humerus are uncommon injuries representing 6% of distal humeral fractures. There is no univocal consensus about the correct management of this type of fracture. A national survey was conducted to gain more insight into the current classification, diagnosis and treatment of coronal shear fractures in Italy.

      Materials and methods

      A postal survey was sent to all AO Italian members including residency orthopaedic surgeons. The survey consisted of general questions about personal experience in the management of these fractures: types of classification systems used, surgical approaches, treatment options and rehabilitation programs.


      114 orthopaedic surgeons answered a 13-items questionnaire. The most used classification system was AO/OTA (72,8%). Independent screws and if necessary plates were the most answered regarding surgical treatment (81,6%). The most encountered post-surgical complication was stiffening of the elbow (81,6%).


      An algorithm of treatment has been proposed. To better classify coronal shear fractures, the authors recommended the integration of two classification systems: AO and Dubberley classifications. In the case of posterior wall comminution, a Kocher extensile approach is recommended, otherwise, if a posterior wall is intact, Kocher or Kaplan approach can be used. The posterior transolecranic approach can be reserved to Dubberley type III or AO 13B3.3. The best treatment choice is represented by independent screws and plates placed according to fracture patterns while arthroplasty is indicated when a stable ORIF is not possible. Mobilization is postponed for about 2 weeks.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Arastu M.H.
        • Kokke M.C.
        • Duffy P.J.
        • Korley R.E.C.
        • Buckley R.E.
        Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management.
        Bone Joint J. 2013; 95 B: 1165-1171
        • McKee M.D.
        • Jupiter J.B.
        • Bamberger H.B.
        Coronal shear fractures of the distal end of the humerus.
        J Bone Joint Surg - Ser A. 1996; 78: 49-54
        • Lopiz Y.
        • Rodríguez-González A.
        • García-Fernández 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
        • C Watts a
        • a Morris
        • Robinson C.M
        Fractures of the distal humeral articular surface.
        J Bone Joint Surg Br. 2007; 89: 510-515
        • Mighell M.
        • Virani N.A.
        • Shannon R.
        • Echols 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
        • Brouwer K.M.
        • Bolmers A.
        • Ring D.
        Quantitative 3-dimensional computed tomography measurement of distal humerus fractures.
        J Shoulder Elbow Surg. 2012; 21: 977-982
        • Singh A.P.
        • Singh A.P.
        Coronal shear fractures of distal humerus: diagnostic and treatment protocols.
        World J Orthop. 2015; 6: 867-876
        • Demitri S.
        • Vicenti G.
        • Carrozzo M.
        • Bizzoca D.
        • De Franceschi D.
        • Moretti B.
        The Masquelet technique in the treatment of a non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss: a case report.
        InjuryInjury. 2018; 49: S58-S62
        • Vicenti G.
        • Bizzoca D.
        • Nappi V.S.S.
        • Moretti F.
        • Carrozzo M.
        • Belviso V.
        • et al.
        Biophysical stimulation of the knee with PEMFs: from bench to bedside.
        J Biol Regul Homeost Agents. 2018; 32: 23-28
        • Rotini R.
        • Ricciarelli M.
        • Guerra E.
        • Marinelli A.
        • Celli A.
        Elbow hemiarthroplasty in distal humeral fractures: indication, surgical technique and results.
        Injury. 2020;
        • DeSimone L.J.
        • Sanchez-Sotelo J.
        Total elbow arthroplasty for distal humerus fractures.
        Orthop Clin North Am. 2013; 44: 381-387
        • Tarallo L.
        • Novi M.
        • Porcellini G.
        • Giorgini A.
        • Micheloni G.
        • Catani F.
        Surgical tips and tricks for coronal shear fractures of the elbow.
        Arch Orthop Trauma Surg. 2021; 141: 261-270
        • Lee J.J.
        • Lawton J.N.
        Coronal shear fractures of the distal humerus.
        J Hand Surg. 2012; 37: 2412-2417
        • Edwards P.
        • Roberts I.
        • Clarke M.
        • DiGuiseppi C.
        • Pratap S.
        • Wentz R.
        • et al.
        Increasing response rates to postal questionnaires: systematic review.
        Br Med J. 2002; 324: 1183-1185
        • Faber K.J.
        Coronal shear fractures of the distal humerus: the capitellum and trochlea.
        Hand Clin. 2004; 20: 455-464
        • Chen N.
        • Ring D.
        Distal Humerus Fractures: shear Fractures of the Humeral Articular Surface. Morrey's the Elbow and its Disorders.
        Elsevier. 2018; : 466-470
        • Carroll M.J.
        • Athwal G.S.
        • King G.J.W.
        • Faber K.J.
        Capitellar and Trochlear Fractures.
        Hand Clin. 2015; 31: 615-630
        • Fram B.R.
        • Seigerman D.A.
        • Ilyas A.M.
        Coronal shear fractures of the distal humerus: a review of diagnosis, treatment, and outcomes.
        Hand. 2019; 16: 577-585
        • Dubberley J.H.
        • Faber K.I.
        • MacDermid J.C.
        • Patterson S.D.
        • King G.J.W.
        Outcome after open reduction and internal fixation of capitellar and trochlear fractures.
        J Bone Joint Surg - Ser A. 2006; 88: 46-54
        • 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
        • Watson J.J.
        • Bellringer S.
        • Phadnis J.
        Coronal shear fractures of the distal humerus: current concepts and surgical techniques.
        Shoulder Elbow. 2020; 12: 124-135
        • Ring D.
        • Jupiter J.B.
        • Gulotta L.
        Articular fractures of the distal part of humerus.
        J Bone Joint Surg - Ser A. 2003; 85: 232-238
        • Ring D.
        Apparent Capitellar Fractures.
        Hand Clin. 2007; 23: 471-479
        • Bilsel K.
        • Atalar A.C.
        • Erdil M.
        • Elmadag M.
        • Sen C.
        • Demirhan M.
        Coronal plane fractures of the distal humerus involving the capitellum and trochlea treated with open reduction internal fixation.
        Arch Orthop Trauma Surg. 2013; 133: 797-804
        • Tanwar Y.S.
        • Kharbanda Y.
        • Jaiswal A.
        • Birla V.
        • Pandit R.
        Retrospective analysis of open reduction and internal fixation of coronal plane fractures of the capitellum and trochlea using the anterolateral approach.
        SICOT J. 2018; 48
        • Lansinger O.
        • Karlsson J.
        • Körner L.
        • Måre K.
        Dislocation of the elbow joint.
        Arch Orthop Trauma Surg. 1984; 102: 183-186
      1. A Greenspan A.N. Radial head-capitellum view: an expanded imaging approach to elbow injury 1987:272–4.

        • Durakbasa M.O.
        • Gumussuyu G.
        • Gungor M.
        • Ermis M.N.
        Distal humeral coronal plane fractures: management, complications and outcome.
        J Shoulder Elbow Surg /Am Shoulder Elbow Surg. 2012; 22 ([et Al]): 560-566
        • Goodman H.J.
        • Choueka J.
        Complex coronal shear fractures of the distal humerus.
        Bull Hosp Jt Dis. 2005; 62: 85—89
        • Nauth A.
        • McKee M.D.
        • Ristevski B.
        • Hall J.
        • Schemitsch E.H.
        Distal humeral fractures in adults.
        J Bone Joint Surg - Ser A. 2011; 93: 686-700
        • Mancini G.B.
        • Fiacca C.
        • Pucci G.
        • Azzarà A.
        The results of a resection intervention in isolated fractures of the radial head.
        Archivio “Putti” Di Chirurgia Degli Organi Di Movimento. 1990; 38: 411-415
        • Robinson C.M.
        • Hill R.M.F.
        • Jacobs N.
        • Dall G.
        Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment.
        J Orthop Trauma. 2003; 17: 38-47
        • Mitani M.
        • Nabeshima Y.
        • Ozaki A.
        • Mori H.
        • Issei N.
        • Fujii H.
        • et al.
        Arthroscopic reduction and percutaneous cannulated screw fixation of a capitellar fracture of the humerus: a case report.
        J Shoulder Elbow Surg. 2009; 18: e6-e9
        • Feldman M.D.
        Arthroscopic excision of type II capitellar fractures.
        Arthroscopy. 1997; 13: 743-748
        • Hardy P.
        • Menguy F.
        • Guillot S.
        Arthroscopic treatment of capitellum fracture of the humerus.
        Arthroscopy. 2002; 18: 422-426
        • Sano S.
        • Rokkaku T.
        • Saito S.
        • Tokunaga S.
        • Abe Y.
        • Moriya H.
        Herbert screw fixation of capitellar fractures.
        J Shoulder Elbow Surg. 2005; 14: 307-311
        • Mahirogullari M.
        • Kiral A.
        • Solakoglu C.
        • Pehlivan O.
        • Akmaz I.
        • Rodop O.
        Treatment of fractures of the humeral capitellum using herbert screws.
        J Hand Surg. 2006; 31: 320-325
        • Vaishya R.
        • Vijay V.
        • Jha G.K.
        • Agarwal A.K.
        Open reduction and internal fixation of capitellar fracture through anterolateral approach with headless double-threaded compression screws: a series of 16 patients.
        J Shoulder Elbow Surg. 2016; 25: 1182-1188
        • 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- Ser A. 2008; 90: 1321-1329
        • 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
        • Felstead A.J.
        • Phadnis J.
        Independent locking screws for articular fragment fixation in the elbow.
        Tech Hand Up Extrem Surg. 2019; 23: 33-37
        • Armstrong A.D.
        • Dunning C.E.
        • Faber K.J.
        • Duck T.R.
        • Johnson J.A.
        • King G.J.
        Rehabilitation of the medial collateral ligament-deficient elbow: an in vitro biomechanical study.
        J Hand Surg Am. 2000; 25: 1051—1057
        • Gelinas J.J.
        • Faber K.J.
        • Patterson S.D.
        • King G.J.W.
        The effectiveness of turnbuckle splinting for elbow contractures.
        J Bone Joint Surg - Ser B. 2000; 82: 74-78
        • Yari S.S.
        Management of distal humeral coronal shear fractures.
        World J Clin Cases. 2015; 3: 405