Chondral Shear Fracture of the Capitellum in Adolescents-A Report of Two Late Diagnosed Cases and a Review of Literature.

The chondral shear fracture is a rare sub-type of pediatric capitellum fractures, in which the fractured fragment is almost entirely cartilaginous. Since the fractured fragment is not visible on plain radiographs, these injuries are often missed on initial presentation resulting in delayed diagnosis and poor outcomes. To our knowledge, only eight such cases have been reported in the past. We report the cases of two adolescents with chondral shear fractures of the capitellum, that were initially missed. They both presented to us several months following trauma, with pain and restricted elbow range of motion. They were treated by excision of the intra-articular loose fragment, and one child also required radial head excision due to advanced radio-capitellar arthritis. Both had good outcomes at 1 year follow-up. We provide a review of literature on this injury and emphasize the need for having a high index of suspicion when dealing with elbow trauma in adolescents, so as to avoid missing this rare, but distinct fracture pattern.