Second fracture of the distal humerus after varus malunion of a supracondylar fracture in children

Takahara, Masatoshi; Sasaki, Isao; Kimura, Takeshi; Kato, Hiroyuki; Minami, Akio; Ogino, Toshihiko

doi:10.1302/0301-620x.80b5.8831

Cited by 40 publications

(18 citation statements)

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“…Although cubitus varus has been conventionally described as a cosmetic deformity with little functional significance, there is growing awareness of long-term complications, including chronic pain, ulnar nerve palsy, 1,2 tardy posterolateral rotatory instability, 3 snapping elbow, 4 and an increased risk of lateral condyle and other secondary fractures. 5,6 Even in the absence of functional problems, which are mostly late sequelae, parents are often dissatisfied with the appearance of their child's arm and request treatment.…”

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confidence: 99%

Supracondylar osteotomy for the treatment of cubitus varus in children

Solfelt

Hill

Anderson

et al. 2014

The Bone & Joint Journal

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Cubitus varus is the most frequent complication following the treatment of supracondylar humeral fractures in children. We investigated data from publications reporting on the surgical management of cubitus varus found in electronic searches of Ovid/MEDLINE and Cochrane Library databases. In 894 children from 40 included studies, the mean age at initial injury was 5.7 years (3 to 8.6) and 9.8 years (4 to 15.7) at the time of secondary correction. The four osteotomy techniques were classified as lateral closing wedge, dome, complex (multiplanar) and distraction osteogenesis. A mean angular correction of 27.6º (18.5° to 37.0°) was achieved across all classes of osteotomy. The meta-analytical summary estimate for overall rate of good to excellent results was 87.8% (95% CI 84.4 to 91.2). No technique was shown to significantly affect the surgical outcome, and the risk of complications across all osteotomy classes was 14.5% (95% CI 10.6 to 18.5). Nerve palsies occurred in 2.53% of cases (95% CI 1.4 to 3.6), although 78.4% were transient. No one technique was found to be statistically safer or more effective than any other.

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confidence: 99%

Supracondylar osteotomy for the treatment of cubitus varus in children

Solfelt

Hill

Anderson

et al. 2014

The Bone & Joint Journal

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“…Takahara13 commented that the metaphysis is thickened after a supracondylar fracture, and that this thickening protects the fracture site from the external forces. In contrast, the epiphysis, or growth plate, weakens against the fracture.…”

Section: Discussionmentioning

confidence: 99%

Refractures of the Upper Extremity in Children

et al. 2007

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PurposeTo investigate the etiologic factors related to refractures of the upper extremity in children.Patients and MethodsEighteen refractures were divided into three groups according to the location of the initial fractures. They were analyzed in terms of the type of refractures, fracture patterns, and the existence of an underlying deformity.ResultsOf nine supracondylar fractures of the humerus, two involved refractures at the supracondylar region, and the other seven involved the lateral condyle. Underlying cubitus varus was present in six cases. Of three lateral condylar fractures of the humerus, one had a refracture at the supracondylar region, and two cases involved the lateral condyle. One had an underlying cubitus varus. All but one case in the humeral fractures group were late refractures, and were treated with surgery. Of six repeat forearm fractures, five were early type and occurred at the original site within nine weeks, four at the diaphysis of both bones of the forearm, and one at the diaphysis of the ulna. All cases in the forearm fractures group, save one, had volar angulation before the refracture, and were treated conservatively.ConclusionIn the humerus, the underlying cubitus varus was the most important predisposing factor for refractures and lateral condyle fractures were common. In the forearm, volar angulation of the diaphysis was related to refractures, and complete and circular consolidation of the primary fracture of the forearm was thought to be important in prevention.

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“…7,[25][26][27] Although cubitus varus has recently been reported to be associated with ulnar neuropathy, 28 snapping of the medial portion of the triceps, 29 secondary distal humeral or lateral condylar fracture, 30 avascular necrosis of the distal humeral epiphysis, 30 and tardy posterolateral rotatory instability of the elbow, 31 in most patients the usual presenting complaint is an unsightly deformity rather than a functional disability. Its reported incidence varies from 4% to 58%.…”

Section: Discussionmentioning

confidence: 99%

Dome Osteotomy for Posttraumatic Cubitus Varus

Pankaj

Dua

Malhotra

et al. 2006

Journal of Pediatric Orthopaedics

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The indication for surgery in most children with posttraumatic cubitus varus is the presence of an unsightly deformity. The function of the limb is generally not impaired. Lateral closing-wedge supracondylar osteotomy, although a widely used corrective procedure, tends to produce lateral condylar prominence, thus jeopardizing the cosmetic outcome. The authors used the dome supracondylar osteotomy, as described by Tien et al, as the corrective procedure for cubitus varus in 12 consecutive children. The average follow-up was 2.3 (range 1-4) years. The objective evaluation was done by one of the authors by measuring the pre- and postoperative lateral condylar prominence index, carrying angle, and the range of movement at the elbow. The patients and parents were also asked to self-assess the cosmetic outcome. There were seven excellent and five good results. None of the children showed a prominent lateral humeral condyle. Hypertrophic scar formation and ulnar neurapraxia were seen in one patient each. These results were comparable to the published results of lateral closing-wedge osteotomy in terms of correction of carrying angle and preservation of elbow motion and were superior to those of the lateral closing-wedge osteotomy in terms of the prominence of lateral humeral condyle, acceptability of the scar, and cosmesis. The authors offer independent verification of the observation that the technique of dome osteotomy as described by Tien et al for the correction of the posttraumatic cubitus varus is a simple, safe, and technically sound procedure that prevents the lateral condyle from becoming prominent and yields an excellent cosmetic outcome.

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Second fracture of the distal humerus after varus malunion of a supracondylar fracture in children

Cited by 40 publications

References 0 publications

Supracondylar osteotomy for the treatment of cubitus varus in children

Supracondylar osteotomy for the treatment of cubitus varus in children

Refractures of the Upper Extremity in Children

Dome Osteotomy for Posttraumatic Cubitus Varus

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