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Oka K, Shiode R, Iwahashi T, Kazui A, Yamamoto N, Miyake T, Murase T, Miyamura S, Tanaka H. Association of Clinical Findings With Complications in the Cubitus Varus Deformity After Supracondylar Fracture. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202410000-00010. [PMID: 39401380 PMCID: PMC11473079 DOI: 10.5435/jaaosglobal-d-24-00272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 08/25/2024] [Indexed: 10/19/2024]
Abstract
INTRODUCTION Cubitus varus deformity is primarily a cosmetic complaint that causes some early and late complications. However, no studies have reported the cubitus varus deformity regarding the frequency of complications, relationship to the degree of deformity, and period from the occurrence of the initial injury. METHODS Overall, 83 patients with cubitus varus deformity were examined. The differences in the humerus-elbow-wrist angle (∆HEW-A), tilting angle (∆TA), and internal rotation angle (∆IRA) between the affected and normal sides were measured to determine varus and extension and internal rotation deformity. The period from the occurrence of the initial injury to the evaluation date was also investigated. Multivariate logistic regression analysis was conducted to identify the explanatory variables (period, ∆HEW-A, ∆TA, and ∆IRA) independently associated with complication events. Receiver-operating characteristic curve analysis was also conducted to predict the risk of events. RESULTS ∆HEW-A was independently associated with the risk of cosmetic complaint (odds ratio [OR], 1.171; 95% confidence interval [95% CI], 1.056 to 1.336) and instability (OR, 1.111; 95% CI, 1.028 to 1.200). ∆TA was independently associated with the risk of limited elbow motion (OR, 1.176; 95% CI, 1.077 to 1.285) and sports disability (OR, 0.892; 95% CI, 0.836 to 0.952). The period from the occurrence of the initial injury was independently associated with risk of pain (OR, 1.063; 95% CI, 1.019 to 1.108), ulnar nerve neuropathy (OR, 1.065; 95% CI, 1.011 to 1.125), and osteoarthritis (OR, 1.188; 95% CI, 1.098 to 1.286). The receiver-operating characteristic curve analysis revealed the optimal cutoffs of 20° and 27° for ∆HEW-A to predict cosmetic complaint and instability; of 25° for ∆TA to predict limited elbow motion; and of 8.8, 8.0, and 16.0 years for the period to predict pain, ulnar nerve neuropathy, and osteoarthritis, respectively. DISCUSSION The treatment of cubitus varus deformity should be determined because a residual deformity >20° of varus and 25° of extension could develop risk of complications over time.
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Affiliation(s)
- Kunihiro Oka
- From the Department of Orthopaedic Biomaterial Science (Dr. Oka) and the Department of Orthopaedic Surgery (Dr. Oka, Dr. Shiode, Dr. Iwahashi, Dr. Kazui, Dr. Yamamoto, Dr. Miyake, Dr. Miyamura, and Dr. Tanaka), Graduate School of Medicine, Osaka University, Osaka, Japan; the Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Japan (Dr. Murase); and the Department of Sports Medical Science, Graduate School of Medicine, Osaka University, Osaka, Japan (Dr. Tanaka)
| | - Ryoya Shiode
- From the Department of Orthopaedic Biomaterial Science (Dr. Oka) and the Department of Orthopaedic Surgery (Dr. Oka, Dr. Shiode, Dr. Iwahashi, Dr. Kazui, Dr. Yamamoto, Dr. Miyake, Dr. Miyamura, and Dr. Tanaka), Graduate School of Medicine, Osaka University, Osaka, Japan; the Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Japan (Dr. Murase); and the Department of Sports Medical Science, Graduate School of Medicine, Osaka University, Osaka, Japan (Dr. Tanaka)
| | - Toru Iwahashi
- From the Department of Orthopaedic Biomaterial Science (Dr. Oka) and the Department of Orthopaedic Surgery (Dr. Oka, Dr. Shiode, Dr. Iwahashi, Dr. Kazui, Dr. Yamamoto, Dr. Miyake, Dr. Miyamura, and Dr. Tanaka), Graduate School of Medicine, Osaka University, Osaka, Japan; the Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Japan (Dr. Murase); and the Department of Sports Medical Science, Graduate School of Medicine, Osaka University, Osaka, Japan (Dr. Tanaka)
| | - Arisa Kazui
- From the Department of Orthopaedic Biomaterial Science (Dr. Oka) and the Department of Orthopaedic Surgery (Dr. Oka, Dr. Shiode, Dr. Iwahashi, Dr. Kazui, Dr. Yamamoto, Dr. Miyake, Dr. Miyamura, and Dr. Tanaka), Graduate School of Medicine, Osaka University, Osaka, Japan; the Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Japan (Dr. Murase); and the Department of Sports Medical Science, Graduate School of Medicine, Osaka University, Osaka, Japan (Dr. Tanaka)
| | - Natsuki Yamamoto
- From the Department of Orthopaedic Biomaterial Science (Dr. Oka) and the Department of Orthopaedic Surgery (Dr. Oka, Dr. Shiode, Dr. Iwahashi, Dr. Kazui, Dr. Yamamoto, Dr. Miyake, Dr. Miyamura, and Dr. Tanaka), Graduate School of Medicine, Osaka University, Osaka, Japan; the Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Japan (Dr. Murase); and the Department of Sports Medical Science, Graduate School of Medicine, Osaka University, Osaka, Japan (Dr. Tanaka)
| | - Tasuku Miyake
- From the Department of Orthopaedic Biomaterial Science (Dr. Oka) and the Department of Orthopaedic Surgery (Dr. Oka, Dr. Shiode, Dr. Iwahashi, Dr. Kazui, Dr. Yamamoto, Dr. Miyake, Dr. Miyamura, and Dr. Tanaka), Graduate School of Medicine, Osaka University, Osaka, Japan; the Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Japan (Dr. Murase); and the Department of Sports Medical Science, Graduate School of Medicine, Osaka University, Osaka, Japan (Dr. Tanaka)
| | - Tsuyoshi Murase
- From the Department of Orthopaedic Biomaterial Science (Dr. Oka) and the Department of Orthopaedic Surgery (Dr. Oka, Dr. Shiode, Dr. Iwahashi, Dr. Kazui, Dr. Yamamoto, Dr. Miyake, Dr. Miyamura, and Dr. Tanaka), Graduate School of Medicine, Osaka University, Osaka, Japan; the Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Japan (Dr. Murase); and the Department of Sports Medical Science, Graduate School of Medicine, Osaka University, Osaka, Japan (Dr. Tanaka)
| | - Satoshi Miyamura
- From the Department of Orthopaedic Biomaterial Science (Dr. Oka) and the Department of Orthopaedic Surgery (Dr. Oka, Dr. Shiode, Dr. Iwahashi, Dr. Kazui, Dr. Yamamoto, Dr. Miyake, Dr. Miyamura, and Dr. Tanaka), Graduate School of Medicine, Osaka University, Osaka, Japan; the Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Japan (Dr. Murase); and the Department of Sports Medical Science, Graduate School of Medicine, Osaka University, Osaka, Japan (Dr. Tanaka)
| | - Hiroyuki Tanaka
- From the Department of Orthopaedic Biomaterial Science (Dr. Oka) and the Department of Orthopaedic Surgery (Dr. Oka, Dr. Shiode, Dr. Iwahashi, Dr. Kazui, Dr. Yamamoto, Dr. Miyake, Dr. Miyamura, and Dr. Tanaka), Graduate School of Medicine, Osaka University, Osaka, Japan; the Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Japan (Dr. Murase); and the Department of Sports Medical Science, Graduate School of Medicine, Osaka University, Osaka, Japan (Dr. Tanaka)
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Miyake T, Miyamura S, Miki R, Shiode R, Iwahashi T, Kazui A, Yamamoto N, Tanaka H, Okada S, Murase T, Oka K. Cubitus varus deformity following paediatric supracondylar humeral fracture remodelling predominantly in the sagittal direction: A three-dimensional analysis of eighty-six cases. INTERNATIONAL ORTHOPAEDICS 2024; 48:2091-2099. [PMID: 38727804 PMCID: PMC11246304 DOI: 10.1007/s00264-024-06197-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/22/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE Three-dimensional (3D) capacity for remodelling in cubitus varus deformity (CVD) after paediatric supracondylar humeral fractures (PSHFs) remains unelucidated. This study investigated remodelling patterns after PSHFs by examining 3D deformity distribution over time after injury. METHODS Computed tomography (CT) data of 86 patients with CVD after PSHFs were analysed. The 3D deformity angles in the sagittal, coronal, and axial directions were assessed and correlated with the duration between the age at injury and CT evaluation. For the subgroup analysis, we performed the same correlation analysis in a younger (< 8 years old) and an older group (≥ 8 years old); we categorized the duration into early (< 2 years), middle (≥ 2 to < 5 years), and late periods (≥ 5 years) and compared the deformity angles of each direction among the three groups. RESULTS Sagittal deformity showed a moderate correlation with the duration of deformity (r = -0.54; P < 0.001), while coronal and axial deformities showed a negligible correlation. Sagittal deformity showed moderate correlations with the duration in the younger group (r = -0.62; P < 0.001) and weak correlations in the older group (r = -0.37; P = 0.091). In the sagittal direction, the deformity angle in the early period was significantly larger than those in the mid and late periods (P < 0.001). However, there were no significant differences among the three groups in the coronal and axial directions. CONCLUSION Sagittal deformities in CVDs are capable of remodelling, especially in the early period and at a younger age, whereas coronal and axial deformities are less likely to undergo remodelling.
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Affiliation(s)
- Tasuku Miyake
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoshi Miyamura
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryo Miki
- Miki Orthopedic Surgery & Internal Medicine, Minoh, Japan
| | - Ryoya Shiode
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toru Iwahashi
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Arisa Kazui
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Natsuki Yamamoto
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroyuki Tanaka
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Sports Medical Science, Osaka University Graduate School of Medicine, Suita, Japan
| | - Seiji Okada
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Murase
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Orthopedic Surgery, Bell Land General Hospital, Sakai, Japan
| | - Kunihiro Oka
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
- Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Japan.
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Schlauch AM, Manske MC, Leshikar HB, Davids JR. Posttraumatic Cubitus Varus: Respect the Columns. J Pediatr Orthop 2024; 44:e518-e529. [PMID: 38515131 DOI: 10.1097/bpo.0000000000002671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Posttraumatic cubitus varus is a multiplanar deformity that results from an improperly reduced supracondylar humerus fracture. The prevention of posttraumatic cubitus varus hinges on the stable restoration of all 3 columns of the distal humerus while avoiding malrotation. The collapse of any column leads to varying degrees of deformity in the coronal, sagittal, and/or axial plane. The purpose of this article is to explain the pattern of the deformity and use this to summarize preventative tactics for avoiding its described sequelae. We also summarize, illustrate, and present case examples for the various osteotomies used to correct the deformity, and speculate future directions.
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Affiliation(s)
- Adam M Schlauch
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program/St. Mary's Medical Center, San Francisco
| | - Mary Claire Manske
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA
| | - Holly B Leshikar
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA
| | - Jon R Davids
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA
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Oka K, Miyamura S, Shiode R, Kazui A, Iwahashi T, Tanaka H, Murase T. Three-dimensional corrective osteotomy for cubitus varus deformity using patient-matched instruments. JSES Int 2024; 8:646-653. [PMID: 38707552 PMCID: PMC11064714 DOI: 10.1016/j.jseint.2024.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Various methods of two or three-dimensional (3D) corrective osteotomy for cubitus varus deformity have been reported. However, whether 3D correction of cubitus varus deformity is necessary is controversial because of technical difficulties and surgical complications. This study introduced 3D simulations and printing technology for corrective osteotomy against cubitus varus deformities. Moreover, recent studies on the application of these technologies were reviewed. Methods The amount of 3D deformity was calculated based on the difference in 3D shape between the affected side and the contralateral normal side. Patient-matched instruments were created to perform the actual surgery as simulated. Further, a 3D corrective osteotomy was performed using patient-matched instruments for cubitus varus deformity in pediatric and adolescent patients. The humerus-elbow-wrist angle, tilting angle, and elbow ranges of motion were evaluated. Results Humerus-elbow-wrist angle and tilting angle were corrected from -21° to 14° and from 30° to 43°, respectively, in the pediatric patient and from -18° to 10° and from 20° to 40°, respectively, in the adolescent patient. The elbow flexion and extension angles changed from 130° to 140° and from 20° to 10°, respectively, in the pediatric patient and from 120° to 130° and from 15° to 0°, respectively, in the adolescent patient. Conclusion The 3D computer simulations and the use of patient-matched instruments for cubitus varus deformity are reliable and can facilitate an accurate and safe correction. These technologies can simplify the complexity of 3D surgical procedures and contribute to the standardization of treatment for cubitus varus deformity.
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Affiliation(s)
- Kunihiro Oka
- Department of Orthopaedic Biomaterial Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Satoshi Miyamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Ryoya Shiode
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Arisa Kazui
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Toru Iwahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Osaka, Japan
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Wu X, Lin R, Chen J, Chen S. Closed reduction with percutaneous Kirschner wire drill-and-pry for pediatric supracondylar humeral fractures with bony callus formation and delayed presentation. Injury 2023; 54:547-551. [PMID: 36529549 DOI: 10.1016/j.injury.2022.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Supracondylar humeral fractures are the most common type of pediatric elbow fractures, and are primarily treated using closed reduction and percutaneous pinning. For patients who are treated ≥14 days after the injury, after callus formation has occurred, closed reduction is usually not possible. The purpose of this study is to report the clinical outcomes of closed reduction with percutaneous Kirschner wire (K-wire) drill-and-pry for the delayed treatment of pediatric supracondylar humeral fractures with bony callus formation. METHODS We retrospectively reviewed the data of 16 patients who underwent percutaneous K-wire drill-and-pry between November 2019 and August 2021 for the treatment of supracondylar humeral fractures with bony callus formation ≥14 days after the injury. Clinical outcomes were assessed using the Flynn criteria. The postoperative Baumann angle and pin configuration were evaluated using x-ray examinations. RESULTS All patients were followed up for 8-28 months (average, 16.63 months). The fractures healed in 4-6 weeks (average, 4.38 weeks). The operative time ranged from 10 to 124 min (average, 35.12 min). No iatrogenic vascular or nerve injury occurred. No patient developed cubitus varus. According to the Flynn criteria, 12 patients had excellent outcomes, 2 patients had good outcomes, 1 patient had a fair outcome and 1 patient had a poor outcome. CONCLUSION Closed reduction with percutaneous K-wire drill-and-pry is a mini invasive technique for supracondylar humeral fractures with bony callus formation in children. Most patients had a good clinical and cosmetic outcomes without scarring.
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Affiliation(s)
- Xinwu Wu
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China; Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou 350007, China; Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Ran Lin
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China
| | - Jinchen Chen
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China
| | - Shunyou Chen
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou 350007, China; Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou 350007, China; Fuzhou Trauma Medical Center, Fuzhou 350007, China.
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Abstract
BACKGROUND Pediatric supracondylar humeral fractures (SCHFs) can heal in hyperextension malunion after casting or surgical treatment. Here the authors present quantitative evidence concerning the ability of children to remodel sagittal plane malunion. Their null hypothesis was that like varus and valgus malunion, children have little capacity to remodel sagittal plane malunion after SCHFs. METHODS The authors performed a prospective longitudinal radiographic study of 41 children, aged 22 to 126 months, who were registered during the study interval. They calculated the percent displacement of the center of the capitellum behind the anterior humeral line (AHL) as the distance of the midpoint of the capitellum from the AHL, divided by the diameter of the capitellum, multiplied by 100. Longitudinal measurements were made using the embedded software on our institution's digital radiographic system. The primary outcome focus was the percent displacement of the center of the capitellum relative to AHL on the initial and on the latest radiograph. RESULTS The average initial displacement (hyperextension) of the capitellum behind the AHL for all patients was 61% (range, 23% to 134%). At an average follow-up of 21 months, 24 children (60%) had remodeled 100% the sagittal plane malunion, 12 children (30%) had remodeled such that the AHL passed through the central third of the capitellum, and 5 children (10%) had minimal or no remodeling. CONCLUSIONS The authors rejected their null hypothesis. Children do have the capacity to remodel radiographically measurable sagittal plane malunion of SCHFs. Children younger than 5 years of age can remodel 100% displacement of the center of the capitellum, whereas those over 8 years of age have minimal remodeling capacity.
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Tan W, Wang FH, Yao JH, Wu WP, Li YB, Ji YL, Qian YP. Percutaneous fixation of neonatal humeral physeal fracture: A case report and review of the literature. World J Clin Cases 2020; 8:4535-4543. [PMID: 33083415 PMCID: PMC7559671 DOI: 10.12998/wjcc.v8.i19.4535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/31/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose. Thus, missed diagnoses and delayed healing are possible. Few studies have reported surgical treatment, because a callus may develop at the fracture site 5 d after the fracture, resulting in difficult reduction, and reduction of the limb may cause further physeal injury. Other surgical challenges include the provision of adequate anesthesia and complexity of the operation. However, without appropriate reduction and fixation, a varus elbow deformity may develop. Manual reduction and percutaneous pin fixation are ideal treatment options.
CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted, and diagnosed with delayed physeal fracture of the distal humerus based on physical examination, ultrasonography, and magnetic resonance imaging. The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography. Postoperatively, the reduction was successful. The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.
CONCLUSION The techniques of manual reduction and percutaneous pin fixation, to treat neonatal distal humeral physeal fractures, are safe and reliable.
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Affiliation(s)
- Wei Tan
- Department of Pediatric Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Fu-Hua Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Jing-Hui Yao
- Department of Pediatric Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Wei-Ping Wu
- Department of Pediatric Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Yi-Bin Li
- Department of Pediatric Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Yue-Lun Ji
- Department of Pediatric Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Yue-Peng Qian
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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Abstract
Distal humeral extension-type malunions may occur as a complication following improper reduction of supracondylar humerus fractures. We evaluated results after distal humeral flexion osteotomies for sagittal realignment of the humeral condyle in children. Medical records and radiographs of all patients younger than 18 years of age, who underwent this procedure because of a clinically relevant lack of elbow flexion, were evaluated. In a cohort of 18 children with a mean age of 8 years at the time of surgery and a mean follow-up duration of 1 year, elbow flexion increased significantly from a mean of 101° preoperatively to 126° at the final follow-up; established radiographic parameters (e.g. anterior humeral line, humerocondylar angle) were normalized as well. The distal humeral flexion osteotomy is a reliable method to efficiently correct extension-type malunions and improve impaired elbow flexion in children.
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Persiani P, Noia G, de Cristo C, Graci J, Gurzì MD, Villani C. Lateral wedge osteotomy for pediatric post-traumatic cubitus varus: Kirschner-wires or locking angular plate? J Pediatr Orthop B 2017; 26:405-411. [PMID: 27014946 DOI: 10.1097/bpb.0000000000000300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study aimed to evaluate and compare two types of internal fixation, locking angular plate (group 1) and Kirschner-wires (group 2), for post-traumatic cubitus varus. The parameters used were Laupattarakasem's criteria (for range of motion in extension/flexion, correction of carrying angle, and the 'lazy S' deformity) and the Barrett's questionnaire (for patient satisfaction). In group I (plate+screws), we had three excellent results and five good. In group II (Kirschner-wires), we had two good results, three fair, and two poor. Statistical analysis showed a better outcome for group I (plate+screws) considering the correction of the humeral-elbow-wrist angle (P<0.003), the postoperative lateral prominence index (P<0.048), and the patient satisfaction (P<0.011). We recommend the locking angular plate, because it can rigidly stabilize the osteotomy, ensuring an excellent functional and cosmetic outcome.
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Affiliation(s)
- Pietro Persiani
- Universitary Department of Anatomic, Histologic, Forensic and Locomotor Apparatus Sciences - Section of Locomotor Apparatus Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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To pin or not to pin? Sagittal alignment of type II supracondylar humeral fractures in children. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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[Treatment of posttraumatic cubitus varus in children and adolescents. Supracondylar humeral osteotomy using radial external fixation]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2015; 27:194-209. [PMID: 26137930 DOI: 10.1007/s00064-015-0403-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/09/2015] [Accepted: 04/12/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Precise adaptable fixation of a supracondylar humerus osteotomy with a radial/lateral external fixator to correct posttraumatic cubitus varus. INDICATIONS Acquired, posttraumatic cubitus varus as a result of a malhealed and unsatisfactorily treated supracondylar humerus fracture. Idiopathic, congenital cubitus varus (very seldom) if the child (independent of age and after complete healing) is cosmetically impaired; stability of the elbow is reduced due to malalignment (hyperextension); secondary problems and pain (e. g., irritation of the ulnar nerve) are expected or already exist; or there is an explicit wish of the child/parents (relative indication). CONTRAINDICATIONS In principle there are no contraindications provided that the indication criteria are filled. The common argument of age does not represent a contraindication in our opinion, since angular remodeling at the distal end of the humerus is practically nonexistent. SURGICAL TECHNIQUE Basically, the surgical technique of the radial external fixator is used as previously described for stabilization of complex supracondylar humeral fractures. With the patient in supine position, the arm is placed freely on an arm table. Using a 4-5 cm long skin incision along the radial, supracondylar, the extracapsular part of the distal humerus is prepared, whereby great caution regarding the radial nerve is advised. In contrast to the procedure used in radial external fixation for supracondylar humeral fracture treatment, two Schanz screws are always fixed in each fragment at a distance of 1.5-2 cm. The osteotomy must allow the fragment to freely move in all directions. The proximal and distal two Schanz screws are then connected with short 4 mm carbon or stainless steel rods. These two rods are connected with each other over another rod using the tub-to-tub technique. Now the preliminary correction according the clinical situation can be performed and the clamps are tightened. Anatomical axis and function are checked. If these are radiologically and clinically perfect, all clamps are definitively tightened; if the alignment or the function is not perfect, then further adjustments can be made. POSTOPERATIVE MANAGEMENT Due to the excellent stability, further immobilization not necessary. Immediate functional follow-up treatment performed according to pain. RESULTS Adequate healing is usually expected within 6 weeks. At this time the external fixator can be removed in the fracture clinic. Because the whole operation is performed in an extraarticular manner and the mobility of the elbow is not affected, deterioration of function has never been observed. Also regarding the cosmetic/anatomical situation, good results are expected because they were already achieved intraoperatively.
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