title: The outcome of early revision of malaligned pediatric supracondylar humerus fractures.
abstract: BACKGROUND
  Supracondylar humerus fractures (SCHF) are the most common elbow fractures requiring surgical treatment in the pediatric age group. Most fractures are reduced and stabilised adequately. Yet, post-surgical malunion may occur. The purpose of this study is to evaluate our results of early revision surgery in 21 surgically treated pediatric SCHF with immediate postoperative loss of alignment and compare them with previous reports of late corrective osteotomies.
  
  
  METHODS
  Twenty-one pediatric SCHF patients that underwent revision surgery for malalignment within 3 weeks of the initial reduction and fixation consisted the study group. Indications for revision were unacceptable radiographic alignment diagnosed within the first 3 weeks after the index surgery. Clinical outcome included pain, range of motion (ROM) and appearance of the elbow. Radiographic outcome was defined as fracture healing and final alignment, assessed in both coronal and sagittal planes.
  
  
  RESULTS
  The average time interval between index and revision surgery was 7.6 days (range 3-18). In revision surgery, closed reduction was performed in 17 out of 21 patients, and open reduction was required in four. In one patient, an external fixator was added. In the most recent follow up, all patients but three regained full ROM. The remaining three had a deficit of 10° or less. Two patients had cubitus varus of 10° or less. All patients had a marked radiographic improvement after revision, especially in the sagittal plane increasing the humero-capitaller flexion angle by an average of 20°.
  
  
  CONCLUSIONS
  Malunion after reduction and Kirschner wires (KW) fixation of SCHF is an uncommonly reported phenomenon. When malunion is recognised after fracture healing, corrective osteotomies may carry a significant complications rate. We describe our favourable experience with early diagnosis and revision surgery of malaligned SCHF.
authors.affiliation: Hebrew University Hadassah Medical Centers, Department of Orthopedics Surgery, Jerusalem, Israel. Electronic address: or@hadassah.org.il.
authors.forename: Omer
authors.initials: O
authors.lastname: Or
authors.affiliation: Hebrew University Hadassah Medical Centers, Department of Orthopedics Surgery, Jerusalem, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Weil
authors.affiliation: Hebrew University Hadassah Medical Centers, Department of Orthopedics Surgery, Jerusalem, Israel.
authors.forename: Naum
authors.initials: N
authors.lastname: Simanovsky
authors.affiliation: Hebrew University Hadassah Medical Centers, Department of Orthopedics Surgery, Jerusalem, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Panski
authors.affiliation: Hebrew University Hadassah Medical Centers, Department of Orthopedics Surgery, Jerusalem, Israel.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Goldman
authors.affiliation: Hebrew University Hadassah Medical Centers, Department of Orthopedics Surgery, Jerusalem, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Lamdan
mesh_terms: D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D007557:Israel / Q000453:epidemiology; D008297:Male; D010027:Osteotomy / Q000706:statistics & numerical data; D059348:Peripheral Nerve Injuries / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Malalignment; Revision; Supra condylar humerus fracture