Correction of Cubitus Varus After Pediatric Supracondylar Elbow Fracture: Alternative Method Using the Taylor Spatial Frame.
BACKGROUND
Cubitus varus is a well-reported complication of supracondylar fracture of the humerus potentially resulting in cosmetic problems, impaired function, and malpractice claims. Traditional methods of correcting malunited distal humeral fractures involve complex osteotomies that have a high complication rate, require a large exposure, and challenging fixation. We present a technique of gradual correction using a percutaneous transverse osteotomy and 3 dimensional correction with a Taylor Spatial Frame.


METHODS
This was a retrospective, IRB-approved study of 12 patients between 2006 and 2010, with cubitus varus after a malunited pediatric supracondylar fracture. The average age at initial injury was 5+8 years. The average age of the patients at surgery was 8+8 years. We measured technical (radiographic parameters and complications), functional (clinical carrying angle, range of motion, QuickDash), and satisfaction domain (questionnaire) outcomes at a minimum follow-up of 6 months.


RESULTS
The osteotomy healed in all patients by 10 weeks after the index surgery. The mean external fixator time was 10 weeks. The average preoperative and postoperative humeroulnar angles for the affected elbow were 23 degrees varus and 5.8 degrees valgus, respectively. This was statistically significant (P<0.001). The mean preoperative and postoperative carrying angles were 22 degrees of varus and 5.8 degrees of valgus. This was statistically significant (P<0.001). The results of the QuickDash assessment showed that patients were doing very well with regard to the use of their upper extremity. The mean symptom/disability score was 0.80. No major complications or neurovascular complications were encountered. Overall satisfaction with the procedure was high.


CONCLUSIONS
The Taylor Spatial Frame as used in this case series provides the experienced surgeon another safe, accurate, and reliable method to correct cubitus varus after pediatric supracondylar fracture. We used in 7 of our 12 cases, a previously unreported pattern of distal humeral pin fixation that allows for a very distal metaphyseal osteotomy, close to the deformity apex. This is a biplanar delta configuration that straddles the olecranon fossa and is appropriate for both children and adults.


METHODS
Level IV.
*Department of Orthopaedic Surgery, Phoenix Children's Hospital, Phoenix, AZ †Department of Orthopaedic Surgery, Miami Children's Hospital, Miami, FL ¶International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD ‡Department of Orthopaedic Surgery, Emek Hospital, Afula ∥Department of Orthopaedic Surgery, Rambam Medical Center, Haifa §Department of Orthopaedic Surgery, Ichilov Hospital, Tel Aviv, Israel.
Mohan V
MV
Belthur
Christopher A
CA
Iobst
Noam
N
Bor
Eitan
E
Segev
Mark
M
Eidelman
Shawn C
SC
Standard
John E
JE
Herzenberg
D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000175:diagnosis / Q000601:surgery; D006811:Humerus / Q000000981:diagnostic imaging; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D011184:Postoperative Period; D016059:Range of Motion, Articular; D012189:Retrospective Studies