A 26-year-old male, manual laborer presented with pain and swelling over left elbow following a fall on an outstretched hand while driving a two-wheeler. There were diffuse swelling and tenderness over lateral elbow joint line. Forearm rotation was associated with pain. Elbow was held in 30° flexion with painful restriction of further flexion. There was no distal neurovascular deficit. An intra-articular displaced capitellum fracture was diagnosed on plain radiographs of the elbow (, ). Computed tomography (CT) images revealed a three-part capitellum fracture pattern with a Y-shaped split of distal humerus, a sheared anterior crescent-shaped fragment, and a single, large posterolateral fragment including the lateral epicondyle. The anterior crescent-shaped capitellum fragment extending up to the lateral part of trochlea was displaced proximally and laterally. The posterior arm of the Y-shaped fracture line exited the posterolateral cortex of distal humerus (,, ). Open reduction and internal fixation (ORIF) was done through an anterolateral Kocher’s interval. Posterior soft-tissue sleeve was left undisturbed. Anatomical articular reduction was temporarily held with two 1.0 mm Kirschner wires (). Headless cannulated screws were not available at this trauma center which is a low-resource health-care setup. Instead, two divergent, countersunk, solid 3.5 mm cortical screws were used to stabilize the articular fragment. Both screws were applied obliquely from anterior-distal to posterior-proximal to ensure adequate far cortex purchase above the unstable posterolateral fragment and to prevent posterior column comminution (). An additional oblique, extra-articular screw was used to fix the posterolateral fragment. Primary LCL repair was done and additional absorbable sutures used to tag the LCL to the intact posterolateral soft-tissue sleeve. Elbow was taken through a full range of movement and valgus and rotational stability was assessed, wound was irrigated and closed over suction drain. Active-assisted elbow range of movement exercises initiated from the 7th post-operative day. At 3 months follow-up, fracture united and the patient regained active elbow flexion from 5° to 130°. He complained of minor pain at terminal elbow extension. Persistent restriction of 5° terminal elbow extension was attributed to suspected impingement of olecranon tip against screw tip. Implant was not removed as the patient has good elbow function and was able to return to work 3 months after surgery. At 1 year and 2 years’ follow-up, elbow range of 5–130° was recorded and Mayo elbow performance score was 95. There was no valgus or posterolateral rotational instability. The patient reported no pain, full elbow flexion, minimal restriction of elbow movement at terminal extension, and no elbow instability. Minimal asymptomatic anterior heterotopic ossification (HO) was noted but it did affect elbow function (, ).