Supracondylar dome osteotomy for cubitus valgus deformity associated with a lateral condylar nonunion in children. Surgical technique.
BACKGROUND
Open reduction, autogenous bone-grafting, and internal fixation for the treatment of established nonunion of the lateral condyle associated with a cubitus valgus deformity has a high rate of complications. As a consequence, we developed a new technique that includes in situ compression fixation of the lateral condylar nonunion and a dome-shaped supracondylar osteotomy of the distal aspect of the humerus through a single posterior incision.


METHODS
Eight consecutive patients were treated with the new surgical technique between 1994 and 2000. The mean age at the time of surgery was 8.6 years. The mean interval between the lateral condylar fracture and surgery was 4.9 years. The mean preoperative radiographic humerus-ulna angle was 31 degrees of valgus. The postoperative results were classified with a modification of the scoring system described by Dhillon et al., which assesses pain, weakness, range of motion, the humerus-ulna angle, and prominence of the medial epicondyle on a 12-point scale.


RESULTS
All eight lateral condylar nonunions achieved union within three months postoperatively. The mean postoperative humerus-ulna angle was 5.5 degrees of valgus. All of the supracondylar dome osteotomies healed uneventfully, and there was no loss of correction postoperatively. The mean duration of follow-up was 4.5 years. The overall results were excellent in two patients, good in four patients, and fair in two patients.


CONCLUSIONS
With better exposure of the lateral condylar nonunion through a posterior approach, we can effectively stabilize the lateral condylar nonunion and avoid postoperative loss of motion and osteonecrosis of the condyle. With a dome-shaped supracondylar osteotomy, we can correct the cubitus valgus deformity and avoid the development of a medial epicondylar prominence. With careful selection of patients, this new technique can be an effective method to treat this clinically challenging problem.
Tien
Yin-Chun
YC
Department of Orthopaedic Surgery, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung City 807, Taiwan, Republic of China.
Chen
Jian-Chih
JC
Fu
Yin-Chih
YC
Chih
Tsai-Tung
TT
Huang
Peng-Ju
PJ
Wang
Gwo-Jaw
GJ
D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D016916:Joint Deformities, Acquired / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D016896:Treatment Outcome