A Rare Adolescent T-Y Distal Humerus Fracture with Capitellar Shear Component Managed Using a Triangular Cannulated Screw Construct and Herbert Screw Fixation: A Rare Case Report.

INTRODUCTION: T-condylar (T-Y) distal humerus fractures are rare intra-articular injuries in adolescents (<2% of pediatric elbow fractures). The coexistence of a capitellar coronal shear fragment is exceptionally uncommon and can be easily missed on radiographs. We report successful management of this rare injury using computed tomography (CT)-guided planning and stable screw fixation. CASE REPORT: A 12-year-old boy presented after a fall with a displaced T-condylar distal humerus fracture. CT demonstrated an associated capitellar coronal shear fragment. Open reduction through a posterior paratricipital approach was performed using a triangular cannulated cancellous screw construct with Herbert screw fixation of the capitellum. Fracture union was achieved uneventfully, implants were removed after union, and the patient regained nearly full elbow motion without deformity, instability, or neurovascular deficit. CONCLUSION: Pre-operative CT is crucial for identifying associated capitellar injuries. A triangular cannulated screw construct combined with Herbert screw fixation provides stable fixation, facilitates early mobilization, and can achieve excellent radiological and functional outcomes in selected adolescent T-condylar fractures.