Bryan-Morrey Type 4 capitellum fractures present unique challenges for screw fixation due to their medial extension. Although both anteroposterior (AP) and posteroanterior (PA) screw orientations have been described, their clinical outcomes have not yet been directly compared.

Twenty-one patients with Bryan-Morrey Type 4 capitellum fractures treated with headless compression screws were retrospectively reviewed. Patients were divided into AP (n = 12) and PA (n = 9) groups based on screw orientation according to the treating surgeon’s preference. Primary outcome was the Mayo Elbow Performance Index (MEPI). Secondary outcomes included range of motion, screw angular parameters, analgesic duration, fluoroscopy count, and complications.

Both groups achieved excellent functional outcomes with no significant difference in MEPI scores (AP: 87.9 ± 7.8 vs. PA: 90.6 ± 5.8; P = .274). The PA group showed reduced postoperative analgesic duration (6.7 ± 2.2 vs. 14.1 ± 3.5 days; P < .001), lower fluoroscopy exposure (5.6 ± 1.0 vs. 7.2 ± 1.1 images; P = .005), and more parallel screw orientation (9.3 ° ± 1.6 ° vs. 16.8 ° ± 7.1 °; P < .001). Although the complication rate trended lower in the PA group (11.1% vs. 41.7%; P = .178), this difference was not statistically significant. Olecranon fossa penetration and transient neuropraxia occurred exclusively in the AP group.

Both AP and PA screw fixation techniques achieved excellent functional outcomes in Bryan-Morrey Type 4 capitellum fractures. The PA technique demonstrated perioperative advantages including reduced analgesic requirements and lower fluoroscopy exposure. These exploratory findings suggest that the PA technique appears promising, but confirmation in larger prospective studies is warranted.

III; Retrospective Comparative Study