title: Pesamosca osteoplasty: surgical procedure for the spatial correction of cubitus varus or valgus post malunited supracondylar fractures of the humerus.
abstract: BACKGROUND
  Supracondylar fractures of the humerus represent a current concern in the child's and adolescent's osteo-articular pathology. Even though orthopedic reductions are made correctly, fractures can become displaced when managed only by cast immobilization and complications may arise. The most frequent complications encountered in "Prof. Dr. Alexandru Pesamosca" Clinique, Bucharest, Romania, due to supracondylar humeral fractures, are valgus or varus deviations with angles that can sometimes exceed 40 degrees as a result of malunion. Varus or valgus deformations were rarely encountered after surgical treatment. The goal of this study is to present an alternative surgical technique to correct varus and valgus deformations as well as malrotation.
  
  
  METHODS
  The study is a retrospective analysis of a 96 children study group surgically managed during 1985 and 2013. In the first period, various surgical techniques have been performed: cuneiform resections, step-cut osteotomies, open wedge osteotomies with external fixation, epiphysiodesis, hemichondrodiatasis and Pesamosca metaphyseal diaphyseal osteoplasty. Starting with 2005, all the cases that presented such complications--28 out of 96 (29.1%)--were managed with the Pesamosca procedure. Due to the malunion of supracondylar humeral fractures only varus or valgus deformities were admitted in the study. The malunion due to the pathologic fractures encountered in osteogenesis imperfecta or fibrous dysplasia was precluded. The experience accumulated with the other surgical techniques used in 68 out of 96 patients (70.9%) determined us to exclusively use the Pesamosca osteoplasty following the year 2005, seeing the simplicity and the efficiency of this procedure.
  
  
  RESULTS
  The outcome was very good. In 5 cases out of the 28 (17%) an apparent residual elbow was encountered and one case of relapse (3%) was noted due to inadequate term of cast immobilization. The elbow's mobility was completely recovered, the thoracic member's axis was appropriate and the metaphyseal diaphyseal osteotomy site healed completely in 3 months' time.
  
  
  CONCLUSIONS
  Compared to other surgical techniques, the Pesamosca technique offers to the surgeon the possibility of correcting the varus or the valgus deformity as well as the malrotation in a simple, secure and efficient manner.
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; "Maria Sklodowska Curie" Children's Clinical Emergency Hospital, Bucharest, Romania ; The Studies and Research Group in Pediatric Orthopedics-2012.
authors.forename: G
authors.initials: G
authors.lastname: Burnei
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; "Maria Sklodowska Curie" Children's Clinical Emergency Hospital, Bucharest, Romania ; The Studies and Research Group in Pediatric Orthopedics-2012.
authors.forename: Ş
authors.initials: Ş
authors.lastname: Gavriliu
authors.affiliation: "Nicolae Testemiţeanu" State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.
authors.forename: I
authors.initials: I
authors.lastname: Nepaliuc
authors.affiliation: "Maria Sklodowska Curie" Children's Clinical Emergency Hospital, Bucharest, Romania ; The Studies and Research Group in Pediatric Orthopedics-2012.
authors.forename: C
authors.initials: C
authors.lastname: Vlad
authors.affiliation: "Maria Sklodowska Curie" Children's Clinical Emergency Hospital, Bucharest, Romania.
authors.forename: M
authors.initials: M
authors.lastname: Drăgoescu
authors.affiliation: "Maria Sklodowska Curie" Children's Clinical Emergency Hospital, Bucharest, Romania ; The Studies and Research Group in Pediatric Orthopedics-2012.
authors.forename: I
authors.initials: I
authors.lastname: Georgescu
authors.affiliation: "Maria Sklodowska Curie" Children's Clinical Emergency Hospital, Bucharest, Romania.
authors.forename: R A
authors.initials: RA
authors.lastname: Ghita
authors.affiliation: Children's Clinical Hospital, Brasov, Romania.
authors.forename: L
authors.initials: L
authors.lastname: Muntean
authors.affiliation: "Floreasca" Clinical Emergency Hospital, Bucharest, Romania.
authors.forename: A A
authors.initials: AA
authors.lastname: Pârvan
authors.affiliation: "St. Spiridon" Clinical Emergency County Hospital, Bucharest, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Dughilă
authors.affiliation: "Maria Sklodowska Curie" Children's Clinical Emergency Hospital, Bucharest, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Ţiripa
authors.affiliation: County Hospital, Tulcea, Romania.
authors.forename: Ş
authors.initials: Ş
authors.lastname: Hamei
authors.affiliation: Q.K.U. University, Pristina, Kosovo.
authors.forename: I
authors.initials: I
authors.lastname: Klinaku
mesh_terms: D002648:Child; D016267:External Fixators; D000071938:Fasciotomy; D005592:Fracture Fixation; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006811:Humerus / Q000000981:diagnostic imaging / Q000473:pathology*; D009132:Muscles / Q000601:surgery; D010027:Osteotomy; D010521:Periosteum / Q000601:surgery; D011300:Preoperative Care; D011826:Radial Nerve / Q000601:surgery; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D038062:Upper Extremity Deformities, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: cubitus varus/ valgus; malrotation; malunion of the supracondylar fracture; metaphyseal diaphyseal distal humeral osteoplasty; spatial correction