Synchronous fractures of the trochlea and the radial neck without elbow dislocation.

Fractures of the articular surface of the distal end of the humerus (i.e., of the capitellum and the trochlea) are rather uncommon injuries. Fractures of the capitellum account for 1% of all elbow fractures and about 6% of all distal humeral fractures. Fractures of the trochlea are usually encountered as part of more complex intra-articular fractures of the distal end of the humerus, disrupting the medial and/or the lateral column of the humerus. Isolated fractures of the articular surface of the trochlea are very infrequent and are sporadically encountered in the literature as case reports, thus there are only a few clinical series dealing with the description and the surgical treatment of this injury. Trochlear fractures usually accompany elbow dislocations or type IV fractures of the capitellum. Unusual complex injuries about the elbow joint that combine fractures and ligamentous disruptions may be difficult to diagnose and treat. The combination of a ligamentous injury and an intra-articular fracture increases the severity of the injury. Simple elbow dislocations where all ligaments are disrupted have a favorable prognosis when treated conservatively, in contrast to complex dislocations that are combined with fractures and that may require surgical intervention to obtain joint stability. We present an unusual case with concomitant, distinct fractures of the trochlea and the radial neck, accompanied by medial collateral ligament (MCL) disruption, caused probably by a combination of injury mechanisms. Our literature review revealed no other similar case.