Treatment of Posttraumatic Cubitus Varus in the Pediatric Population with Humeral Osteotomy and External Fixation

Mj, Levine; Bd, Horn; Pd, Pizzutillo

doi:10.1097/00004694-199609000-00010

Cited by 21 publications

(14 citation statements)

References 15 publications

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“…1,4 Previous authors 3,5,6 have described surgical techniques for medial translation of the distal fragment to avoid this complication. Milch 7 suggested that angular correction and lateral shift of the distal fragment were required to avoid prominence of the medial condyle after supracondylar osteotomy for cubitus valgus occurring after a Milch type-II lateral condylar fracture.…”

Section: Discussionmentioning

confidence: 99%

“…1 In adults, however, plate fixation is difficult and often inadequate, especially when displacement or rotation of the distal fragment is required after supracondylar osteotomy to reduce a prominent lateral condyle in cubitus varus or a prominent medial condyle in cubitus valgus. The use of a monolateral external fixator for stabilisation of the fragments after closing or open wedge osteotomies for the treatment of cubitus varus in children has been described by King and Secor 2 and Levine, Horn and Pizzutillo, 3 but there are no reports of the use of this technique in adults. The method gives acute correction of three-dimensional deformities and allows early movement of the elbow after surgery, without the risk of loss of correction.…”

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confidence: 99%

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Supracondylar Osteotomy With Ilizarov Fixation for Elbow Deformities in Adults

Song¹,

Cho²,

Jeong³

et al. 1997

The Journal of Bone and Joint Surgery. British volume

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Stable fixation after a corrective supracondylar osteotomy in adults is difficult because of the irregularity of the area of bony contact, displacement of the fragments, the predominance of cortical bone, and the need for early mobilisation.We have used the Ilizarov apparatus for fixation in 15 patients who were treated by complex osteotomies with displacement of fragments for cubitus varus or valgus. Most patients with cubitus varus required medial displacement with rotation of the distal fragment. Those with cubitus valgus required lateral shift of the distal fragment to reduce the medial prominence of the elbow that would otherwise result.All osteotomies united within the expected time without loss of correction, despite early mobilisation. Complications related to the fixation were few and had resolved at the long-term follow-up. Cubitus varus or valgus is a common complication of supracondylar or lateral condylar fractures of the humerus. Operation is often required to improve the appearance in cubitus varus and to correct tardy palsy of the ulnar nerve in cubitus valgus. Many methods have been described to fix the fragments after a corrective osteotomy. In children, French's technique using Kirschner wires or screws is adequate.1 In adults, however, plate fixation is difficult and often inadequate, especially when displacement or rotation of the distal fragment is required after supracondylar osteotomy to reduce a prominent lateral condyle in cubitus varus or a prominent medial condyle in cubitus valgus. The use of a monolateral external fixator for stabilisation of the fragments after closing or open wedge osteotomies for the treatment of cubitus varus in children has been described by King and Secor 2 and Levine, Horn and Pizzutillo, 3 but there are no reports of the use of this technique in adults. The method gives acute correction of three-dimensional deformities and allows early movement of the elbow after surgery, without the risk of loss of correction. Our aim was to evaluate the results and complications of the supracondylar closing wedge osteotomy in the treatment of elbow deformities in which the Ilizarov apparatus was used for stabilisation. PATIENTS AND METHODSWe studied eight patients with cubitus varus and seven with cubitus valgus. There were nine men and six women with a mean age of 22 years (15 to 41). The average interval between the fracture and the corrective osteotomy was ten years. Seven patients had cubitus varus after malunion of a supracondylar fracture and one developed the deformity after a lateral condylar fracture with hypoplasia of the trochlea. Valgus deformities occurred after Milch type-II lateral condylar fractures of the distal humerus in four patients, Milch type-I fractures in one and dislocation of the radial head in two. All patients with cubitus valgus had tardy palsy of the ulnar nerve. In the patients with cubitus varus we used a closing lateral wedge valgus osteotomy with medial displacement of the distal fragment ( Fig. 1) and in those with cubitus valgus, a clos...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Supracondylar Osteotomy With Ilizarov Fixation for Elbow Deformities in Adults

Song¹,

Cho²,

Jeong³

et al. 1997

The Journal of Bone and Joint Surgery. British volume

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“…Thus, accurate planning is emphasized before surgery. Additionally, some authors have reported another disadvantage, hypertrophic scars, compared with the external fixation methods [10,13,21]. The external fixation procedure has some advantages: further adjustment and f the deformity was corrected.…”

Section: Discussionmentioning

confidence: 99%

“…The external fixation procedure has some advantages: further adjustment and f the deformity was corrected. His elbow ROM is shown after correction are possible after the operation and it does not have bone loss or a prominent device; however, it can lead to pin tract infection or elbow stiffness [17,21] and is not tolerated as well as internal fixation [10]. Some authors have described corrective osteotomies for cubitus varus.…”

Section: Discussionmentioning

confidence: 99%

Surgical Technique: Spike Translation: A New Modification in Step-cut Osteotomy for Cubitus Varus Deformity

Moradi

Vahedi

Ebrahimzadeh

2013

Clinical Orthopaedics &Amp; Related Research

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Background Various methods of osteotomy have been proposed for the treatment of cubitus varus. We designed a modification of the step-cut osteotomy to achieve more correction of the deformity. We describe this new technique called spike translation step-cut osteotomy and report the clinical and radiographic outcomes (deformity correction, ROM, function, osteotomy healing, complications) in a series of patients treated for cubitus varus using this technique. Description of TechniqueThe technique involves a kind of closing-wedge osteotomy with a lateral spike to correct cubitus varus. To avoid lateral epicondyle prominence, the spike is translated medially and embedded in the proximal segment. Methods We treated 13 patients with cubitus varus using the new technique between 2005 and 2010. We compared preoperative and postoperative clinical and radiographic parameters (humerus-elbow-wrist angle, lateral prominence index, arc of elbow motion, DASH score) for all patients. Time to union was recorded. Postoperative evaluation was performed according to the modified criteria of Oppenheim et al. Minimum followup was 16 months (average, 27 months; range, 16-43 months). ResultsThe average humerus-elbow-wrist angle improved from À26°to 11°. The mean lateral prominence index did not differ after correction of deformity compared with the normal side. By using our rehabilitation protocol, all patients regained preoperative arcs of elbow motion in a mean of 2.5 months (range, 1.50-3.50 months) postoperatively, and the mean union time was 1.65 months. According to the criteria of Oppenheim et al., there were 11 excellent and two good results. Conclusions Our spike translation step-cut osteotomy with a larger contact surface of cancellous bone can be a reasonable alternative for correction of a cubitus varus deformity, with satisfactory deformity correction, reliable healing of osteotomy, and low complication rates. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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“…Levine et al used external fixation in five patients. They reported no loss of correction or motion while observing one transient radial neurapraxia, one superficial pin infection, and one keloid [26].…”

Section: Introductionmentioning

confidence: 99%

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

Skaggs

Glassman

Weiss

et al. 2011

Journal of Children's Orthopaedics

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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.

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Treatment of Posttraumatic Cubitus Varus in the Pediatric Population with Humeral Osteotomy and External Fixation

Cited by 21 publications

References 15 publications

Supracondylar Osteotomy With Ilizarov Fixation for Elbow Deformities in Adults

Supracondylar Osteotomy With Ilizarov Fixation for Elbow Deformities in Adults

Surgical Technique: Spike Translation: A New Modification in Step-cut Osteotomy for Cubitus Varus Deformity

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

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