Purpose: This study aimed to determine the functional and radiographic outcomes following corrective distal humeral osteotomies for the treatment of supracondylar fracture malunions in children. We hypothesized that such secondary reconstructive procedures could restore a reasonable and near-normal amount of functionality in a large patient cohort at a tertiary referral center. Methods: We retrospectively reviewed the clinical and radiological records of 38 children who underwent corrective osteotomy for posttraumatic supracondylar humeral malunion using K-wire fixation. All clinical data were extracted after chart review, including age, sex, dominant side whenever available, follow-up duration, and elbow range of motion preoperatively and at the final visit. Radiographic parameters, including Baumann’s angle, humeroulnar angle, humerocondylar angle, and elbow range of motion were evaluated preoperatively, postoperatively, and at the final visit to identify the surgical correction outcomes. Results: The mean age of the patients at fracture was 5.6 (±2.7) years, and the mean age at surgical intervention was 8.6 (±2.6) years. The mean follow-up period of the current series was 28.2 (±31.1) months. Baumann’s angle, humeroulnar angle, and humerocondylar angle were successfully restored to physiological ranges (72.6°, 5.4°, and 36.1°, respectively). Postoperatively, elbow extension improved from -22° (±5.7) to -2.7° (±7.2) versus flexion from 115° (±13.2) to 128.2° (±11.1). Three revision surgeries (8%) were encountered. Conclusions: Corrective osteotomy of the distal humerus with K-wire fixation is a reliable method to efficiently correct malunion of the distal humerus in different planes, thereby improving elbow range of motion and appearance. Level of evidence: level IV: Retrospective therapeutic study.
Management of bone fractures must achieve both reduction and stability. However, dermatological conditions such as dystrophic epidermolysis bullosa can lead to catastrophic events when operating on the patient’s bone fracture, possibly leading to wound infections and fracture nonunion. Here, we report the case of a 20-year-old female with dystrophic epidermolysis bullosa who had suffered from a femur fracture after a fall from the bed. The fracture management was challenging due to the severe condition; however, the use of the Nancy nail was efficient. Due to the rarity of the disease, modifications due to the challenges faced during the patient care approach were accomplished to prevent any harm to the patient. Even though the management was challenging, the outcome was good.
BackgroundThe management of bone fractures must achieve both the reduction and stability providence. However, dermatological conditions such as dystrophic epidermolysis bullosa (DEB) for instance can lead to catastrophic events when operating on the patient’s bone fracture. This can lead to wound infections and possible failure of bone healing leading to fracture nonunion. This dermatological disorder leads to heterogenous bullous dermatoses including cutaneous fragility leading to cutaneous bullous formation after exposure to any type of trauma. DEB is a rare inherited form of the disease characterized by the formation of cutaneous bullae. DEB is associated with a genetic mutation of COL7A1 gene that encodes collagen type VII. Due to the rarity and uniqueness of the disease, special modifications due to the challenges faced during the patient care approach were accomplished to prevent any possible harm to the patient. In this study, we propose a case report that is followed by the anesthetic and surgical challenges faced and how they were modified upon.Case PresentationA 20-year-old female presented to the emergency department with a spiral mid-diaphyseal fracture of the femur after an incidence of falling from bed. The patient was previously diagnosed with dystrophic epidermolysis bullosa which made this case unique and complex. As the patient was examined by the team, her skin was covered with old blisters and wounds that have developed with the consequence of the disease. Due to the sophisticated dermatological condition and the unique presentation, the established multidisciplinary team took a decision to treat the patient with flexible intramedullary nailing in an open versus closed reduction technique, and modifications of the treatment approach were done based on the challenges in this case. The goal was to provide the management while minimizing the risk of infections and complications that would have arisen. The proposed case will set a baseline for the management of similar cases.ConclusionsWe suggest that in order to manage femur shaft fracture in the setting of dystrophic epidermolysis bullosa, modifying the management to avoid the least possible skin harm at any expense while managing the bone fracture is the golden approach.
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