A new surgical technique for the treatment of supracondylar humerus fracture malunions in children

Abstract

Purpose To report a new locking lateral closing wedge osteotomy used in repairing pediatric supracondylar humerus fracture malunions, which allows for coronal and sagittal plane correction of both cubitus varus and extension. Methods At our institution, eight children with cubitus varus resulting from prior supracondylar humerus fracture malunions underwent a new technique of lateral closing wedge osteotomy performed by a single surgeon. Preoperative templating created from radiographs of the bilateral upper extremities were compared with clinical exam to determine the angle of triangular bone that must be removed in order to correct the varus and any extension deformity. A lateral approach and subperiosteal dissection exposed the distal humerus. A transverse osteotomy created a proximal and distal fragment, from which two triangles of bone were removed. The fragments were reunited, parallel lateral pins were placed, and live imaging confirmed stable fixation. Results The osteotomy was performed in eight patients, with an average age of 6.3 years. The mean interval between the initial injury and corrective osteotomy was 2.4 years. All patients ended up with flexion of 130°or greater with full and symmetrical pronation and supination. The average ulnohumeral angular correction was 25.5°, which was within 2°of the uninvolved elbow in seven patients and to within 5°in one patient. Baumann's angle averaged 85.3°preoperatively and 73.7°postoperatively, with an average 70.2°in the uninvolved elbow. All of the patients healed with excellent clinical and radiographic alignment and complete function. There were no complications or revisions. Conclusion Varus malunion is a well-described complication of pediatric supracondylar humerus fracture repairs, and many different osteotomy techniques have been described. This series demonstrates that an interlocking lateral wedge osteotomy with parallel lateral pin fixation can provide reliable correction of varus and extension deformity, with a minimal complication rate.

Complications of open reduction and internal fixation of distal humerus fractures

“…An intra-articular distal humerus malunion is a disabling condition which presents with stiffness, pain, posterolateral rotatory instability, ulnar nerve palsy, weakness, deformity, post-traumatic osteoarthritis and an increased risk of lateral condylar fractures due to the malunion. 62 Knowledge of treating intra-articular malunited fractures of the distal humerus is sparse as there are not enough reports in the literature. 61,63 Intra-articular corrective osteotomy should mostly be considered for young patients who present with moderate to severe functional disability and/or pain and secondary post-traumatic arthritis at an early stage.…”

Postoperative accuracy analysis of three-dimensional corrective osteotomy for cubitus varus deformity with a custom-made surgical guide based on computer simulation

“…1,11,16,17,24,25 To solve these problems, several methods of corrective osteotomy have been performed. [3][4][5][6][7][8][9]14,15,32,37 However, conventional corrective osteotomy can leave a certain degree of deformity because it is not always easy to correct complex 3D bone deformities with preoperative planning based on plain radiographs and free-hand operation. 9,10,15,30,38 Since 2003, we have been developing an original computer program that employs 3D imaging to simulate anatomic correction of the upper limb deformity based on computed tomography (CT) data.…”

Correction of Pediatric Cubitus Varus by Centralization of the Distal Humeral Fragment: A Surgical Technique to Avoid Lateral Condylar Prominence

“…The reported osteotomies have their own advantages and disadvantages. 1,6,9,[15][16][17] The technique described by Skaggs et al 18 can only correct coronal and sagittal deformities but cannot correct rotational deformities. Furthermore, it puts forward better requirements for osteotomy accuracy and is technically challenging.…”