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A Rare Case of Isolated Fracture of Trochlea - A Case Report

 Somanna M S *, Amarnath Savur D, Sudhakar Shetty M ,  Umanand Mallya P

* Dept of Orthopedics, Kasturba medical college, Mangalore

Address for Correspondence:  

Dr Somanna M S
Dept of Orthopedics,
Kasturba Medical College,


Isolated fractures of Trochlea are extremely rare. Very few authors report having seen these fractures. Laugier is credited with its original description in 1853.

The anatomy of the Trochlea probably contributes to its rarity as compared to the capitellum. The Trochlea is situated deep within the elbow joint and thus protected from direct injury. The transmitted force of the ulna tends to produce a wedging action than a tangential shearing force. The rarity of this fracture is likely to cause misdiagnosis and improper management.

We report a case of isolated fracture of the Trochlea sustained by a patient following a road traffic accident. This case is presented for its rarity and outcome.

 J.Orthopaedics 2008;5(3)e5


Isolated fracture of the Trochlea is a rare entity. Only a handful of  cases have been reported in literature; in our review of literature we came across only five cases1,2,3,4,5. Stimson has credited Laugier with its description in 1853, hence it is also known as Laugier’s fracture6.  

Case Report:

A thirty five year old truck driver presented to our casualty with complaints of pain and restricted movement of the right elbow following a motor vehicular accident. On examination he had tenderness over the medial aspect of the elbow and painful restriction of movements. Radiograph of the elbow revealed a fracture line over the medial aspect of distal end of humerus and inferior to the media epicondyle in the standard Antero-posterior view and, the lateral view showing anteriorly and proximally displaced half moon shaped fracture fragment similar to that seen in fracture capitellum. A computed tomographic scan was done to further assess the fracture with regards to the size of the fragment, intra articular extension of the fracture line and the displacement. The scan revealed a coronal fracture of the right Trochlea with anterior and proximal displacement of the fragment of size 0.8û0.5 cm.

X-ray ® Elbow showing the fracture fragment


CT scan showing the fracture

 The fracture was exposed through a medial approach to the elbow; the ulnar nerve was identified and protected. The fracture was reduced and temporarily fixed using Kirschner wires. The fracture reduction was checked using image intensifier and was fixed using two 4 mm partially threaded cancellous screws.

Post operatively the limb was immobilized in an above elbow plaster slab for ten days and active flexion-extension exercises begun in a functional brace. The brace was removed after four weeks.

Patient was regularly followed up once in two weeks till the fracture healed. Check radiographs were obtained at the tenth post op day and at the end of six weeks. After six weeks radiograph showed no loss of reduction with healing of the fracture. At this stage, the elbow was found to be stable with flexion 200 -1200 which was painless. The patient was followed up till 1 year. At the last follow up, the patient was pain free, having returned to his pre-injury occupation with full elbow movements and no evidence of elbow instability. The functional result was excellent according to functional rating scale of Broberg and Morrey7.

Post operative X ray

flexion at the end of six weeks


Discussion :

Fracture of the Trochlea has been previously described as part of the more complex fractures of distal end of humerus and fracture dislocation of elbow 8; however it has been very rarely reported as an isolated injury1,2,3,4,5.

The anatomy of the Trochlea probably contributes to the rarity of this type of injury; it is deeply situated in the elbow joint and thus protected from direct injury9,10. The transmitted force of the ulna tends to produce a wedging action than a tangential shear force10. Worrel attributed the cause of an isolated trochlear fracture to a force transmitted from the palm of the hand through the ulna to the trochlea following a fall on the outstretched hand with the elbow extended5.

As the fracture involves the osteochondral part of the distal humerus it may be difficult to assess accurately on standard radiographs11. It has been stated that, the one finding that should lead the surgeon to suspect a fracture of the trochlea is a fragment lying on the medial side of the joint just distal to the  medial epicondyle12.  Two modified lateral views have been described for better assessment of complex elbow injuries. A “radial head capitellar” view might be required to exclude injuries to the coronoid and type II fractures of the capitellum.13 A “coronoid trochlear” view delineates the trochlea and coronoid free of overlap of other bones.14 When in doubt a CT scan is helpful for delineating the extent and type of fracture more accurately.

The operative treatment of these fractures may be equally difficult given the limited amount of sub chondral bone available for stable internal fixation of the fracture fragments8, 11.

Failure to reduce this fracture anatomically may adversely affect not only the arc of flexion and extension of the elbow but also the intrinsic stability of the elbow provided by the Trochlea- olecranon articulation10, 12.


Sonography is a useful modality in diagnosis of severe CTS. We found out a decrease in anteroposterior diameter of carpal tunnel in severe cases of this disease. A finding which has not been considered previously. This finding of narrow carpal tunnel may be considered as a predisposing factor in severe CTS. To evaluate the US results in mild to moderate disease, more study will be needed.

Reference :

1. D.A. Foulk, P.A. Robertson and L.A. Timmerman, Fracture of trochlea, J Orthop Trauma 9 (1995) (6), pp. 530–532.

2. Kaushal, R. , Bhanot, A. , Gupta, P.N. Isolated shear fracture of humeral trochlea  (2005) Injury Extra

3. Kwan, M.K. , Khoo, E.H. , Chua, Y.P. Isolated displaced fracture of humeral trochlea: A report of two rare cases (2007) Injury Extra

4. A.Oberstein, K.F. Kreitner, A. Lowe and I. Michiels, Isolated fracture of trochlea humeri following direct elbow trauma, Aktuelle Radiol 4 (1994) (5), pp. 271–273

5. R.V. Worrel, Isolated displaced fracture of the trochlea, NY State J Med 71 (1971) (19), pp. 2314–2315
6. Stimson L A, A treatise on fracture, Philadelphia, Henry C Lea & co, 1890

7. M.A. Broberg and B.F. Morrey, Results of delayed excision of radial head after fracture, J Bone Joint Surg 68(A) (1996), pp. 669–674.

8. Gejrot,W,: On intra-articular fractures of the capitellum and Trochlea of the humerus with special reference to the treatment.Acta Chir Scandinavica,71:253-270,1932.

9. Bryan, RS ; Fractures about the elbow in adults, Instr Course Lect, 30: 200 – 223, 1981

10. Eliason, EL & North, JP: Fracture about the elbow, Amr. J. Surg, 44: 88 – 99, 1939.

11. Mckee,MD;Jupiter,JB;Bamberger,HB: Coronal shear fracture of the distal end of the humerus.J. Bone and Joint Surg.78,49-54,1996.

12. Smith, FM; Surgery of the elbow ; 2nd ed, Philadelphia; W B Saunders 1972

13. A.Greenspan, A. Norman and H. Rosen, Radial head-capitellum view in elbow trauma: clinical application and radiographic-anatomic correlation, Am J Reontgenol 143 (1984) (2), pp. 355–359

14. J.C. Guilbeau, M.M. Monelhi and H. Nahum, Modified profiles of the elbow in traumatology: the value of radial head-capitellum view and a new coronoid-trochlea view, J Radiol 65 (1986) (5), pp. 439–444


This is a peer reviewed paper 

Please cite as : Somanna M S : A Rare Case of Isolated Fracture of Trochlea - A Case Report

J.Orthopaedics 2008;5(3)e5





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