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Osteochondral Fractures of the Capitellum

Osteochondral fractures are those that damage the cartilage and the subchondral bone beneath it. Fractures of the capitellum fall into four main categories, of which, only one falls into the category of osteochondral fractures.

They are:

Only Type II falls into the category of Osteochondral fractures of the capitellum. 

Symptoms include:

• Elbow pain 
• wrist pain
• Swelling in the elbow
• Tenderness

Elbow fractures of the capitellum make up only 1% of overall elbow fractures.

To better understand the condition, we have to first get acquainted with the anatomy of the human elbow.

What is Osteochondral Fractures of the Capitellum?

The term osteochondral literally refers to the bone under the cartilage where ‘osteo’ means the bone beneath and ‘chondral’ means the articular cartilage. As mentioned earlier, osteochondral fractures are those that damage not only the bone but also the cartilage.

The capitellum could translate to little head and represents the inferior anterior part of the humerus or the humeral condyle (lateral). The Type II fractures of the capitellum are shear fractures of the articular cartilage where the cartilage nearly separates from the bone.

Common Symptoms of Osteochondral Fractures of the Capitellum

Symptoms include:

• Elbow pain
• Pain may extend to the wrist
• Swelling
• Elbow deformity
• Limited range of movement - mechanical lock when rotating, extending, or flexing the elbow.

Physical examination may show signs of tenderness in the elbow combined with swelling.

The doctor will also check the range of motion during the initial diagnosis. The doctor will also check the stability of the elbow to identify the severity of the condition and then verify the initial diagnosis via an X-ray.

What Causes Osteochondral Fractures of the Capitellum?

You can get an osteochondral fracture of the capitellum in multiple ways.

• If you fall on an outstretched arm
• Fall when you are standing
• Falling on or hitting a semi flexed-elbow.

A low-impact fall on the elbow or a fall on the open hand with the impact radiating to the elbow can also cause osteochondral fractures of the capitellum.

Direct axial compression on a semi-flexed elbow can also generate shear force to cause damage to the osteochondral fractures.

Other Conditions That Are Similar to Osteochondral Fractures of the Capitellum

There are very few conditions that are similar to that of the osteochondral fractures of the capitellum. They include:

• The terrible triad of the elbow
• Radial head fractures
• Many distal humerus fractures
• Osteochondritis dissecans

Who is at Risk of Developing Osteochondral Fractures of the Capitellum?

Unfortunately, everyone is at risk of osteochondral fractures of the capitellum.

• However, athletes, children, and those who are physically active are at a higher risk.
• Workers and construction workers, and those suffering from Panners disease and Osteochondritis Dissecans are also at risk.
• Females are typically also at higher risk because of the carrying angle of the elbow.

Treatment for Osteochondral fractures of the Capitellum

To provide optimal treatment, you need to understand the complexity and the nature of the fracture. Mostly doctors resort to surgical procedures. Often the type II fractures of the capitellum remain unnoticed even after a CT scan and are only discovered during open reduction.

In the open reduction, the surgical realigns the bone and inserts metal pins, plates, or other tools to keep it in place to aid healing. Following the operation, you will have to take pain medication, keep the incision clean, and keep the joint completely pressure-free to aid the healing process.

The hardware installed remains embedded in the bone and becomes part of the elbow even after the bone heals, which is why the patient requires post-operative care, including physical therapy.

How Can phoenix rehab Physiotherapy Help?

Physiotherapy is crucial to the recovery of osteochondral fractures of the capitellum.

After the surgical treatment is complete, the patient had to keep the arm immobile to ensure the bones remain in place as secured by the additional hardware.

By the time the bone heals, the joint is extremely stiff, with a very limited range of motion.

Conservative Physiotherapy

After your doctor gives you the go-ahead, your physiotherapist may start with conservative exercises to slowly get your joint and arm accustomed to movements. They do so in a controlled environment with the help of equipment that reduces the pressure on the elbow during movements.

Wrist Extension and Flexion Exercise Hand Therapy

1. Place the lower arm over a table or a flat surface, with your elbow resting on the surface, and let your wrist hang down the side.
2. Carefully and slowly flex and extend your wrist by bending your wrist to point your fingers downward and then upwards.
   
3. Hold each position for 4-5 seconds each time and continue alternating the position for 5-10 minutes.
   
4. Try to bend your wrist as far as possible without straining the wrist or the elbow joint.

Passive Elbow Flexion

1. Resting your elbow on a soft surface, use your good arm, the one without the surgery, to bend the elbow of the arm that’s undergone surgery.
   
2. Try to use the good arm only for support and don’t exert pressure with it. Here you are trying to resort full functionality to the elbow that has undergone surgery.
   
3. Try to use your joint muscle and strength as much as possible and bend as far as you can without overstraining the joint.

Ball Squeeze

1. To restore arm, wrist, and elbow strength, hold a squeezable ball in your hand and squeeze it.
   
2. Hold the position for a few seconds before letting go and repeat for as many times as you like.
   
3. You can repeat this exercise multiple times throughout the day but make sure you don’t end up overworking your arm muscles as that can increase stiffness instead of reducing it.

All these mentioned above are an active range of motion exercises that help reduce joint stiffness and restore range of motion. Slowly once your range of motion is restored, the physiotherapist will start strength-building exercises. These can include resistance training and some muscle-building exercises.

Band Elbow Flexion

1. These are similar to passive elbow flexion in terms of movement, but here you add a resistance band to the mix.
   
2. Stand up straight and secure the band under your foot and hold the other end in the wrist of the arm that’s undergone surgery.
   
3. With your arms straight down your side, flex your elbow to pull up the resistance band as high as possible.

Pull-Ups

1. You can do pull-ups on pull-ups bars or rings.
2. Hold your arms up straight above your head and grab onto the ring or the bars. Make sure you place your hands shoulder-width apart, and your arms make a 180-degree angle.
3. Try to pull up your body weight by flexing your arms as needed. This requires a substantial amount of elbow, arm, and shoulder strength, and you may not be able to perform this exercise in the first couple of weeks post-operation.

Open Chain Rotations

1. Here you put your lower arm on a table or a flat top surface.
   
2. Position it so that the elbow rests on the surface, and the wrist hangs over it.
   
3. You will hold a dumbbell in your hand and bend your wrist from side to side to create a 180-degree arc.
   
4. Make sure your elbow stays in place, and you only move your wrist.
   
5. The movement requires strength and control, which can help post-operative recovery.

Elbow Extensions Weighted

1. Elbow extensions are the opposite of elbow flexion.
   
2. Pick up a dumbbell and flex your elbow so that you are holding the dumbbell up to your shoulder as close to the body as possible with your upper arm in a straight line.
3.  Then slowly extend the arm to make a 90-degree angle with your upper and lower arm and repeat the movement.

Make sure you perform all these exercises under the supervision of a certified hand therapist or physiotherapist so that you don’t end up injuring the elbow again.