Lateral Condylar Fracture of the Humerus Following Posttraumatic Cubitus Varus

Davids, Jon R.; Maguire, Moira; Mubarak, Scott J.; Wenger, Dennis R.

doi:10.1097/01241398-199407000-00009

Cited by 109 publications

(55 citation statements)

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“…1,4 However, studies have suggested that (1) there may be an increased incidence of lateral condyle fractures; (2) a snapping medial triceps over the malunited medial epicondyle can be painful; (3) tardy ulnar nerve syndrome can occur; and (4) tardy posterolateral rotatory instability can occur, eventually leading to degenerative changes in the elbow. [5][6][7][8] Cubitus valgus deformity does not occur as commonly as cubitus varus deformity and is not as well documented in the literature. 9,10 This deformity causes functional loss of extension and can result in the development of tardy ulnar nerve palsy as well.…”

Section: Discussionmentioning

confidence: 90%

Arthroscopic Correction of a Supracondylar Malunion in a Child

Koehler

Sakamoto

Abernathie

et al. 2015

Arthroscopy Techniques

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Malunions are a well-recognized complication of pediatric supracondylar humeral fractures. Results of corrective osteotomies vary, and complication rates have been reported to be as high as 40%. Considering the high rate of complications for malunion correction, we investigated the feasibility of arthroscopy. We present a technique for arthroscopic supracondylar osteotomy and percutaneous pinning. There are many advantages of an arthroscopic approach to malunion correction, including extension-type deformity correction, safe access to the anterior humerus, and minimal dissection and scarring; any intracapsular contracture can be addressed as well. Elbow arthroscopy appears to be a viable option in the pediatric orthopaedic surgeon's armamentarium. S upracondylar humeral fractures are common in children aged younger than 10 years.1 Angular deformities of the distal humerus are common after supracondylar fractures. 2 The results of corrective osteotomies vary widely, and complication rates have been reported at 33%.2 Considering the high rate of complications for supracondylar humeral malunions, we investigated the feasibility of using arthroscopy. In addition, the complex bony anatomy of the elbow and close proximity of vital neurovascular structures make exposure challenging and, often, limited. Further complicating exposure is the need to avoid damaging the ligaments, which could potentially exacerbate the injury. We present a technique for arthroscopic supracondylar osteotomy and percutaneous pinning. IndicationsThe principal surgical indication for this technique is a supracondylar humeral malunion that results in loss of functional motion (Table 1). In addition to addressing bony malunion, this approach affords the surgeon the opportunity to address any intracapsular contracture concomitantly. ContraindicationsContraindications for this technique revolve around exposure. If arthroscopy does not improve exposure, the procedure should be abandoned in favor of a traditional open osteotomy. In addition, this approach demands an experienced elbow arthroscopist comfortable with pediatric elbow arthroscopy. Lastly, if there has been prior ulnar nerve transposition, we find that elbow arthroscopy is generally contraindicated. Preoperative PlanningPreoperative planning is necessary to determine the requisite dimensions of the osteotomy and degree of correction. Therefore it is important to obtain goodquality preoperative radiographs. The radiographs must comprise true lateral and true anteroposterior views. Then, using elementary trigonometry and compensating for the magnification factor of the radiographs, we select our osteotomy site and plan for the amount of correction necessary to provide the patient with a functional range of motion. We use the techniques detailed by Kim et al. 3 to determine the preoperative angles and degree of malrotation. The humerus-elbow-wrist angle is measured on the anteroposterior radiograph as described previously to assess the varus and valgus angles.

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Section: Discussionmentioning

confidence: 90%

Arthroscopic Correction of a Supracondylar Malunion in a Child

Koehler

Sakamoto

Abernathie

et al. 2015

Arthroscopy Techniques

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“…Cubitus varus has been considered as being just a cosmetic problem by many authors. Nonetheless, there are many functional complications resulting from this deformity which also affect the quality of life of the young patients, such as posterolateral instability and constant painful subluxation of the elbow, damage to the function of the ulnar nerve, predisposition to fractures of the radial condyle and to a posterior luxation of the shoulder (Abe et al, 1995;Beuerlein et al, 2004;Davids et al, 1994;O'Driscoll et al, 2001;Ogino et al, 1986;Uchida & Sugioka, 1990). As there exists minimal to no potential of remodeling in the frontal plane, patients have to undergo another operation to correct the deformity (Flynn et al, 1974;Jain et al, 2000;Wessel et al, 2003).…”

Section: Discussionmentioning

confidence: 97%

Biomechanical comparison of different external fixator configurations for stabilization of supracondylar humerus fractures in children

Hohloch

Konstantinidis

Wagner

et al. 2016

Clinical Biomechanics

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“…Cubitus varus deformity in addition to cosmetic appearance, result in elbow discomfort, pain, tardy posterolateral rotational instability, increased risk of lateral condyle fractures and late ulnar nerve palsies which may be indications for correction of deformity with a supracondylar humeral osteotomy. [25], [26], [27], [28], [29], [30], [31], [32], [33] FINAL DIAGNOSIS Clinicoradiologically, it was a case of left-sided cubitus varus deformity with internal rotation of left forearm with posteromedial subluxation and restricted movement of left elbow in a 9-year-old boy due to united ill-developed medial condyle of humerus following its treatment by closed J. Evolution Med. Dent.…”

Section: Pathological Discussionmentioning

confidence: 99%