Abstract
Introduction
Isolated trochlea fractures are very rare and have only been described previously as case reports.
Aims
To report on a case of isolated trochlea fracture and to present a review of the literature.
Results
There have only been four previous reports of isolated trochlea fracture. Our fifth case is included in the analysis of the literature given below.
Average age 26 (Range 12–33). 60% female, 80% left sided. Dominance only stated in 40% of cases- 50% dominant side. Mechanism of injury: 60% low velocity fall onto an outstretched hand, 40% high velocity- RTA & fall off horse- exact mechanism of injury unknown. Patients all presented with elbow held in flexion, pain and swelling over the medial aspect and a painfully reduced range of motion. Diagnosis made on plain radiographs in 80%, tomograms required in 20%. AP noted to be essential to differentiate from more common capitellum fracture. 20% of fractures associated with comminution. Management consisted of open reduction through a medial approach and internal fixation in 80% (20% headless screw, 20% k-wire, 40% 4.0mm partially threaded cancellous screws) and olecranon traction in 20%. Elbows were immobilised from 3 to 8 weeks. Time to union ranged from 6 weeks (80%) to 13 weeks (20%). Outcomes were uniformly excellent with 40% being asymptomatic with a FROM, 20% asymptomatic with 10 degrees loss of extension and 40% asymptomatic with 5–20 degrees loss of flexion. There were no reported complications.
Conclusion
These are rare injuries and can occur through high and low energy mechanisms. They tend to occur in younger age groups. Diagnosis can be made readily with plain radiographs- the AP is essential in differentiating it from the more common capitellum fracture. The prognosis for this intra-articular fracture is good to excellent.
