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Type IV capitellum fractures in children
  1. Yvonne-Mary Papamerkouriou1,
  2. Pantelis Tsoumpos2,
  3. George Tagaris2 and
  4. George Christodoulou2
  1. 1 Athens General Children’s Hospital “Pan. & Aglaia Kyriakou”, Athens, Attica, Greece
  2. 2 Karamandaneio Children’s Hospital, Patras, Greece
  1. Correspondence to Dr Yvonne-Mary Papamerkouriou, ympapamerkouriou{at}


Capitellum fractures represent 1% of elbow fractures. A coronal shear fracture which involves the trochlea is classified as a type IV McKee fracture. The combination of its rarity in the paediatric population as well as its unique appearance on X-ray make diagnosis of this fracture a challenge. We present the case of a 14-year-old boy who sustained this fracture falling from his bike. It was diagnosed from the double arc sign on X-ray. In addition, a CT scan was obtained to aid preoperative planning. It was treated by open reduction and fixation with two headless compression screws. Follow-up at 6 months showed no avascular necrosis. The patient could achieve full extension, while flexion was reduced only by 5°. Final follow-up was conducted at 15 months. Anatomic reduction and stable internal fixation are essential for a good outcome in these uncommon paediatric fractures.

  • orthopaedic and trauma surgery
  • trauma
  • paediatric surgery
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  • Contributors Y-MP and PT contributed in performing diagnostic imaging as well as the surgical procedure, and senior authors GT and GC were responsible for guidance in the approach and treatment of the patient. All authors contributed to the clinical reviews of the patient. Y-MP and PT were responsible for drafting the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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