Surgical management of isolated humeral trochlear fracture: A rare case report

INTRODUCTION: Isolated humeral trochlea fracture is a rarely reported entity, because theoretically it inaccessible to direct trauma. The mechanism of this injury is still under speculation, also consistent with the limited information available, and a medical consensus on the management does not exist. We report the case of a patient with an isolated trochlea fracture and discuss the underlying mechanisms and the clinical, radiological and therapeutic features of this injury. This work will significantly advance our understanding of this particular fracture. CASE PRESENTATION: A 19-year-old man received an elbow injury after a fall. An anteroposterior radiograph showed an irregularity of the medial joint space, and an intra-articular half-moon-shaped fragment that had moved up and forward at lateral view radiograph. A computed tomography scan confirmed an isolated fracture of the trochlea. Open reduction and internal fixation were performed, resulting the good outcome. DISCUSSION: Isolated trochlear fracture in adults is rare and usually associated with capitellar fracture and/or elbow dislocation. The mechanism of injury behind distal humeral fractures is under speculation with reported in the literature are the result of both high-energy and low-energy traumas. Radiographs and CT scan can be used as the modality for imaging studies, but diagnosis is based on the results of a CT scan. CONCLUSION: An isolated fracture of the trochlea is rare. The mechanisms that generate this fracture are complex. As with other front-line fractures of the humeral distal end, we recommend open reduction and internal fixation for displaced fracture.