Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series

Abed, Yasser Youssef; Nour, Khaled; Kandil, Yasser; El-Negery, Abed

doi:10.1007/s00264-017-3709-6

Cited by 20 publications

(34 citation statements)

References 40 publications

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“…La osteotomía que presentamos es monoplanar, y no permitiría la corrección en todos los planos. 6,7,14,15 Las críticas a esta osteotomía incluyen: que no permite una corrección rotatoria, provee menor estabilidad por ser una osteotomía lineal y aumenta la prominencia medial, pues no permite la traslación del fragmento distal. Las tres osteotomías publicadas con más frecuencia son la de cuña en cierre, la traslacional escalonada en V y la cupuliforme.…”

Section: Resultsunclassified

Osteotomía en cuña sustractiva supracondílea para el tratamiento del codo valgo del adulto

Gallucci

Altube²,

Boretto

et al. 2021

Rev. Asoc. Arg. Ort. y Traumatol

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Objetivo: Comunicar los resultados de una serie de adultos con consolidaciones en valgo del codo tratados con una osteotomía en cuña sustractiva monoplanar. Materiales y Métodos: Se incluyeron 5 pacientes. Se describe la técnica quirúrgica que consistió en un abordaje posterior paratricipital, resección en cuña sustractiva y transposición anterior del nervio cubital. El seguimiento promedio fue de 17 meses. Resultados: Se trató a 4 hombres y una mujer, con una edad promedio de 27 años. La movilidad preoperatoria promedio fue de 138º-7° y la posoperatoria, de 138-6°, el puntaje de dolor en la EAV fue de 4 y 1, el MEPS de 71 y 97, y el DASH de 26 y 8, respectivamente. La evaluación radiográfica preoperatoria arrojó un valgo promedio de 30º con un valgo contralateral de 11º. La corrección radiográfica demostró un valgo de 13º. Se obtuvo una corrección promedio de 2° menos que del otro lado. Todas las osteotomías consolidaron, y la medición de la prominencia medial fue, en promedio, un 32% mayor que en el preoperatorio. Según la escala de Oppenheim, el resultado fue excelente en 4 pacientes y bueno en uno. La satisfacción personal fue, en promedio, de 8,6. Conclusiones: La osteotomía en cuña sustractiva para tratar un codo valgo es una buena opción terapéutica, con recuperación de valores angulares comparables con el lado contralateral, y alta tasa de satisfacción de los pacientes. Como es una técnica menos compleja que las osteotomías multiplanares, es nuestra elección ante una consolidación viciosa en valgo del codo del adulto.

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Section: Resultsunclassified

Osteotomía en cuña sustractiva supracondílea para el tratamiento del codo valgo del adulto

Gallucci

Altube²,

Boretto

et al. 2021

Rev. Asoc. Arg. Ort. y Traumatol

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“…According to Dellon's literature review of over 50 articles reporting more than 2,000 patients, there was no statistical difference in the effect of various treatments for ulnar nerve compression [17]. Abed et al treated nonunion of the lateral humeral condyle using a triple management ( xation of the nonunion site, dome corrective osteotomy, and anterior transposition of ulnar nerve) through a modi ed para-triceptal approach, the results showed that all patients gained union, all gained excellent or good elbow function according to the Mayo elbow performance score [18]. However, there is still controversy about whether to treat the nonunion or not because of complications like stiffness of elbow and avascular necrosis of the fragment [11].…”

Section: Discussionmentioning

confidence: 99%

“…3) The blood supply of the lateral condyle of the humerus should be protected. Studies have shown that lateral condylar epiphyseal vascular supply goes through the posterior part of the articular surface of the condyle to reach the lateral condyle, while protection of the blood supply of the nonunited fragment is the key to successful management [5,8,18]. Therefore, the integrity of the soft tissue and vascular supply should be protected.…”

Section: Discussionmentioning

confidence: 99%

The effect of staged surgical treatment for cubitus valgus after non-union of lateral condylar fracture of distal humerus in older children

Liu¹,

Xie²,

Deng³

et al. 2020

Preprint

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Background: The purpose of this study was to investigate the effect of staged surgery (open reduction/internal fixation and osteotomy) for cubitus valgus after non-union of lateral condylar fractures of the distal humerus in older children.Methods: From January 2010 to January 2013, 9 patients were treated with two-staged surgery (open reduction/internal fixation and osteotomy). The study included 5 males and 4 females, with a mean age of 12.7 years. The interval from fracture to the first surgery was 8.2 years on average. All patients had symptoms of injury of the ulnar nerve and instability of the elbow. The first surgery included internal reduction, internal fixation, and bone grafting, exposing the elbow through a lateral approach. The procedure included clearing the peripheric callus and proximal distal fracture end cicatrix with rongeur until cancellous bone was exposed, and fixation of the lateral condylar fragment with a hollow screw 4.0 mm in diameter and smooth Kirschner wire. The limb was immobilized in a long arm cast with the elbow at 90 degrees of flexion and the forearm in neutral rotation for 3 weeks, and active exercises were begun after removal. The second surgery, osteotomy of the supracondylar humerus, was completed after 6 months to correct cubitus valgus. Internal fixation from the osteotomy was removed 6 months later.Results: Six months after the second surgery, follow-up revealed that in all patients the lateral condylar fractures attained clinical union and cubitus valgus was corrected. Elbow function recovered well without arthrochalasis or humeral condylar avascular necrosis. All patients’ ulnar nerve injury symptoms disappeared.Conclusion: Staged surgery to treat cubitus valgus secondary to lateral condylar fracture non-union in older children serves to first provide elbow stability, then to correct cubitus valgus. Staged treatment may make up for the deficiencies of conventional treatment. However, due to our relatively short follow-up time, the long term effects are unknown.

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“…15 Abed et al treated nonunion of the lateral humeral condyle using a triple management ( xation of the nonunion site, dome corrective osteotomy, and anterior transposition of ulnar nerve) through a modi ed para-triceptal approach, the results showed that all patients gained union, all gained excellent or good elbow function according to the Mayo elbow performance score. 16 However, there is still controversy about whether to treat the nonunion or not because of complications like stiffness of elbow and avascular necrosis of the fragment. 17 In the past, the main treatment for lateral condylar fractures with non-union was osteotomy surgery to correct elbow valgus deformity.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that lateral condylar epiphyseal vascular supply goes through the posterior part of the articular surface of the condyle to reach the lateral condyle, while protection of the blood supply of the nonunited fragment is the key to successful management. 3,4,16 Therefore, the integrity of the soft tissue and vascular supply should be protected.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Staged Surgical Treatment for Cubitus Valgus After Non-Union of Lateral Condylar Fracture of Distal Humerus in Older Children

Liu¹,

Xie²,

Deng³

et al. 2020

Preprint

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Background: The purpose of this study was to investigate the effect of staged surgery (open reduction/internal fixation and osteotomy) for cubitus valgus after non-union of lateral condylar fractures of the distal humerus in older children.Methods: From January 2010 to January 2013, 9 patients were treated with two-staged surgery (open reduction/internal fixation and osteotomy). The study included 5 males and 4 females, with a mean age of 12.7 years. The minimum interval from fracture to the first surgery was 7 years and the maximum interval was 10 years (average 8.2 years). All patients had symptoms of injury of the ulnar nerve and instability of the elbow. The first surgery included internal reduction, internal fixation, and bone grafting, exposing the elbow through a Kocher lateral approach. The procedure included clearing the peripheric callus and proximal distal fracture end cicatrix with rongeur until cancellous bone was exposed, and fixation of the lateral condylar fragment with a hollow screw 4.0 mm in diameter and smooth Kirschner wire. The limb was immobilized in a long arm cast with the elbow at 90 degrees of flexion and the forearm in neutral rotation for 3 weeks, and active exercises were begun after removal. The internal fixation hardware was removed after 3 months. The second surgery, osteotomy of the supracondylar humerus, was completed after 6 months to correct cubitus valgus. Internal fixation from the osteotomy was removed 6 months later.Results: Six months after the second surgery, follow-up revealed that in all patients the lateral condylar fractures attained clinical union and cubitus valgus was corrected. Elbow function recovered well without arthrochalasis or humeral condylar avascular necrosis. All patients’ ulnar nerve injury symptoms disappeared.Conclusion: Staged surgery to treat cubitus valgus secondary to lateral condylar fracture non-union in older children serves to first provide elbow stability, then to correct cubitus valgus. Staged treatment may make up for the deficiencies of conventional treatment. However, due to our relatively short follow-up time, the long term effects are unknown.

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Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series

Cited by 20 publications

References 40 publications

Osteotomía en cuña sustractiva supracondílea para el tratamiento del codo valgo del adulto

Osteotomía en cuña sustractiva supracondílea para el tratamiento del codo valgo del adulto

The effect of staged surgical treatment for cubitus valgus after non-union of lateral condylar fracture of distal humerus in older children

The Effect of Staged Surgical Treatment for Cubitus Valgus After Non-Union of Lateral Condylar Fracture of Distal Humerus in Older Children

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