Supracondylar Osteotomies of Posttraumatic Distal Humeral Deformities in Young Adults - Technique and Results

Abstract

Background: Cubitus varus deformity is the most common late complication after distal humeral fractures in children. Typical symptoms are increasing instability especially the posterolateral rotatory instability (POLRI), lateral elbow pain and cosmetic problems. Different ways of correction have been described but a gold standard has not yet been established.Methods: In this study the clinical outcome 6,5 months after supracondylar closed wedge osteotomy stabilized with locking plates in four young adults was investigated: three with a posttraumatic varus deformity and one with a posttraumatic valgus deformity of the distal humerus.Results: All patients showed good or excellent results in the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand score (DASH). In one case, a revision because of a delayed union was necessary, in another case a preexisting pseudarthrosis of the radial epicondyle remained. Neither a residual instability of the elbow joint, nor any significant prominence of the lateral epicondyle was observed.Conclusion: The supracondylar closed wedge osteotomy stabilized by a locking plate is an effective procedure for the correction of posttraumatic distal humerus deformities in young adults with good final functional results.

Lateral wedge osteotomy for pediatric post-traumatic cubitus varus: Kirschner-wires or locking angular plate?

“…Buß FR et all. [3] had the same results in his cases report, recommending the using of closed wedge osteotomy and plate.…”

“…Different ways of osteotomies and different methods of fixation with k-wires, external fixation, screws or plates have been published. [3,6,19,20] Preoperative planning is important so that the surgeon can consider the pitfalls ahead of time. [18] The lateral approach triceps-sparing, used in this study, is easier and safer compared to posterior approach in particular considering the nerve palsies.…”

“…Recently an increasing number of studies have shown good and excellent clinical results for the treatment with closing wedge osteotomy and plate [1,2,3,7,10,17].…”

“…The incidence of cubitus varus following supracondylar fracture of the humerus is high between 10% to 50%, even if is higher in fractures originally managed conservatively. [1,2,3,4] This deformity is the result of malunion, which includes medial tilting in coronal plane, extension in the sagittal plane, internal rotation of the distal fragment in the horizontal plane. [5,6] The hourglass shape in the sagittal plane of the supracondylar humerus provides a very little contact between the bony fragments, and thus the distal segment may slip medially to produce cubitus varus.…”

Translation step-cut osteotomy for posttraumatic Cubitus Varus in adults: a retrospective study

“…In addition, protrusion of the lateral condyle or S-shaped deformity of the elbow may develop postoperatively [ 20 , 21 ]. Buß et al [ 22 ] have recommended supracondylar humerus closed wedge osteotomy with a locking plate fixation in adults. Moon et al [ 21 ] have suggested medialization of the distal fragment for an effective treatment of cubitus varus deformity with minimized risk of ‘lazy S’ deformity.…”