The problem of post-traumatic varization of the distal end of the humerus remaining after the recovery of a supracondylar fracture

Abstract

We aimed to determine whether the distal end of the humerus had the capacity of spontaneous realignment of the remaining deformity following an inadequate reposition of the supracondylar fracture. The results in 56 children with a supracondylar humerus fracture were analysed. In 45 patients (80%), manual repositioning was performed along with transcutaneous fixation, whereas in 11 patients (20%), only manual repositioning and immobilization in plaster cast was applied. Immobilization was removed and physical therapy was started in all patients on the 21st day following the intervention. Anteroposterior and left-lateral radiography was performed and Baumann's angle was determined. Follow-up radiograph of the elbow of the traumatized and healthy extremity was performed at an interval of 5-15 years (median 9.4). There was no statistically significant difference between the relationship of Baumann's angle of the injured arm measured on the 21st day after the reduction of fragments on the one hand and the carrying angle of the injured and healthy arm measured at the long-term follow-up on the other (t=0.48, P=0.63). Similarly, there was no statistically significant difference between the relationship of Baumann's angle of the injured arm measured at the long-term follow-up and the findings of the carrying angle of both the injured and the healthy arm obtained on the same examination (t=0.78, P=0.44). On the basis of our experience, we conclude that there is no biological capacity to rectify a possible remaining postreduction varus deformity by spontaneous remodelling.

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

“…The severe cubitus varus represents an unacceptable deformity and does not improve with remodeling, so it is necessary surgery. [1,5,8,9,10,15].…”

“…[5,7] The deformity is unsightly and does not improve with remodelling. [1,5,8,9]. Although function is not greatly impaired, the child's parents often request an operation to improve the appearance of the elbow.…”

Three-dimensional corrective osteotomy for cubitus varus deformity using patient-matched instruments

“…Extension deformities may be remodeled along the joint plane of motion until the age of 10; however, the distal humerus has little ability to spontaneously correct varus and internal rotation deformities. 5 , 15 , 42 , 48 Therefore, 3D correction for a cubitus varus deformity is recommended.…”

Posttraumatic Cubitus Varus: Respect the Columns

“…The current standard of care to correct coronal and rotational deformities is an osteotomy. 49,50 While it is difficult to determine a threshold varus angle to indicate a patient for osteotomy, patients appear to compensate for angles < 20 degrees in the coronal and sagittal plane. 2,11,45 Osteotomy options include lateral closing wedge, step-cut, dome, external-fixator (ex-fix) assisted/minimally invasive techniques, and 3D printed assisted osteotomies.…”