The humeral capitellar fracture is a less common periariticular fracture, often resulting from a coronal fracture of the humerus capitulum in the forearm impacted by the radius head during a fall. Kimball et al. pointed out in their report that the incidence of humeral capitellar fracture is only 1%, but it usually leads to severe elbow dysfunction. If the force applied is large, it may also cause damage to the radial head, external epicondyle, olecranon, humeral capitulum, posterior condyle, and medial and lateral collateral ligaments. Reconstruction of the condylar angle of the humerus, repair of the fractured articular surface, stabilization of the elbow joint, and early exercise are the keys to restoring the elbow joint function. However, the reduction and fixation of the fracture during surgery are often tricky, which requires our doctors to make detailed planning and design of surgical programs before surgery to achieve sound therapeutic effects.

To summarize the experience in treating humeral capitellar fracture by lateral elbow joint approach and to investigate its clinical diagnosis, classification, and internal fixation methods.

A retrospective analysis was performed on 26 adult patients with humeral capitellar fractures admitted to Shanghai Yueyang Hospital of Integrated Traditional Chinese and Western Medicine and Shanghai First People's Hospital from January 2017 to December 2021. Among them, 11 were male, 15 were female, 14 were left and 12 were right. Their ages ranged from 28 to 71 years old, with an average age of 38. According to Dubberley classification, there were 6 cases of typeⅠA, 2 cases of typeⅠB, 10 cases of typeⅡA, 2 cases of typeⅡB, and 4 cases of typeⅢA. There was 1 case with ipsilateral Mason II radial head fracture and 1 case with olecranon fracture. The lateral elbow approach was used in all cases. Depending on the location and size of the fracture fragment, the humeral capitulum was fixed with anteroposterior or posteroanterior screws after reduction. For Dubberley type B fracture involving trochlea, lateral condyle, or unstable posterior condyle lateral column, the lateral column stability is restored with buttress plate fixation.

A total of 26 patients were followed up for 12 to 36 months. There was no nerve or vascular injury during and after the operation, and the mean healing time after fracture was 10 weeks. The mean flexion and extension of the elbow was 112° (30-150°) , and the mean rotation of the forearm was 145°. According to Broberg-Morrey scoring criteria, the average score of 26 patients was 92.5 points, and the postoperative excellent and good rate was 91.8%. There was 1 case of ischemic necrosis of the humeral capitulum at 8 months after surgery and 2 cases of brachioradiitis after mild trauma (Grade 1 Broberg-Morrey) . One patient with ectopic ossification (Grade I) had good elbow motion without special treatment.

Through the different intermuscular spaces of the lateral approach of the elbow joint, the humeral capitellar fracture end can be better exposed to achieve adequate fixation.