Surgical management of an isolated humeral trochlear fracture: A rare case report and literature review

Abstract

Introduction and importance

Isolated humeral trochlear fractures are extremely rare compared to their capitellar counterparts. The articular notch of the olecranon and coronoid process typically protects the trochlea from direct trauma, as it lacks any direct muscular or ligamentous attachments. The mechanisms that lead to such fractures are still a topic of speculation.

Case presentation

A 28-year-old male presented with an elbow injury following a road traffic accident (RTA). Initial anteroposterior radiographs revealed irregularity of the medial joint space and an intra-articular half-moon-shaped fragment displaced anteriorly and superiorly, as seen on the lateral view. A computed tomography (CT) scan confirmed an isolated fracture of the trochlea. The patient underwent open reduction and internal fixation (ORIF), which resulted in a favorable outcome. After three months of follow-up, the patient had a stable, painless elbow with a normal range of motion.

Clinical discussion

The purpose of this case report is to discuss the mechanisms and the diagnostic-therapeutic challenges associated with isolated humeral trochlear fractures. The surgery was performed by an orthopedic hand surgeon with seven years of experience. The outcome was assessed based on the significant improvement in the range of motion and the absence of neurological disturbances.

Conclusion

Isolated fractures of the humeral trochlea are rare and complex. Due to limited information and a lack of high-level studies on this injury, no standard treatment protocol exists. Based on previous reports and positive outcomes, we recommend open reduction and internal fixation for such fractures.