title: Complications of supracondylar osteotomies for cubitus varus.
abstract: BACKGROUND
  Humeral osteotomies for cubitus varus have a notoriously high complication rate. Pitfalls of this difficult procedure are highlighted.
  
  
  METHODS
  A 50-year experience of 68 consecutive surgeries was reviewed. Factors such as surgical approach and fixation technique were compared for complication incidence and type.
  
  
  RESULTS
  Seventeen patients (25%) had 23 (34%) clinically remarkable complications. Nine postoperative nerve palsies occurred in 8 patients. Loss of reduction requiring revision or manipulation was seen in 3 patients. The following complications were noted in 2 patients each: nonunion, loss of flexion, lateral prominence, and unsatisfactory scar. Growth arrest, osteomyelitis, and under-correction requiring revision each occurred once. A lateral, triceps-sparing approach was associated with an overall prevalence of complications of 24% (5 of 21) equivalent to the posterior, triceps splitting approach of 24% (10 of 42). An olecranon osteotomy was used in 2 patients both with complications. No nerve injuries occurred in patients who underwent a lateral approach, whereas nerve palsies occurred in 14% (6 of 42) of the patients where a posterior approach was used. An olecranon osteotomy was used in 2 patients with nerve injury occurring in both. A medial approach in 2 patients and a combined medial-lateral approach in 1 patient were used with no complications. Plate and screw fixation was implemented in 29 cases with complications occurring in 6 of them; pin fixation, in 30 cases, 7 of which had complications. There was a higher incidence of under-correction requiring additional surgery with plate fixation (1 of 29) compared with pin fixation which had no under correction but had loss of fixation in 2 of 30. The average correction obtained was similar in the group with complications (32 degrees) versus those without (27 degrees).
  
  
  CONCLUSIONS
  Supracondylar humeral osteotomy is a technically demanding procedure fraught with complications. Plate fixation and pin fixation techniques resulted in similar complication rates, but the surgical approach used appeared to make a difference. The posterior, triceps splitting, approach resulted in a high incidence of nerve palsies versus none with the lateral, triceps-sparing approach.
  
  
  METHODS
  This is a retrospective case series, Level IV.
authors.affiliation: Shriners Hospitals for Children, Honolulu, HI, USA. eraney@shrinenet.org
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Raney
authors.forename: Zachary
authors.initials: Z
authors.lastname: Thielen
authors.forename: Shelley
authors.initials: S
authors.lastname: Gregory
authors.forename: Mary
authors.initials: M
authors.lastname: Sobralske
mesh_terms: D000293:Adolescent; D001858:Bone Nails; D001860:Bone Plates; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000002:abnormalities / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications; D006811:Humerus / Q000601:surgery; D016916:Joint Deformities, Acquired / Q000473:pathology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult