DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20185329

Evaluation of management of malunited supracondylar fracture of humerus by lateral closing wedge osteotomy

Bharati Pankaj Deokar Sharma, Pankaj Nandkishor Sharma

Abstract


Background: Various osteotomies have been in use for correction of varus deformity at elbow secondary to malunited supracondylar humerus fracture in children. The objectives of the study were to determine the efficacy & outcome of lateral closing wedge osteotomy in children as a treatment of malunited supracondylar fracture of humerus with cubitus varus and to evaluate various technical problems, morbidity, complications of Lateral closing wedge osteotomy and to suggest ways to overcome them.

Methods: This prospective study was conducted among 50 cases of malunited supracondylar fracture of humerus who visited in OPD during 1st September 2008 to 31st August 2010. After pre-operative assessment, lateral closing wedge osteotomy was done and fixed with two 3.5 mm screws, figure of eight tension band stainless steel wire and a supplemental lateral k-wire. Post operatively x-ray of patient was taken and carrying angle and range of movement were calculated. Patients were re-assessed at complete union.

Results: Maximum patients were from the age group of 8 to 10 years- 22 cases, mean age 13.08 years, 80% male. Left (non-dominant) side was involved in 30 (60%) cases. Around 18% cases developed complications. 25 (50%) patients had no loss of range of movement and 2 (4%) had 16 to 20 degrees loss of range of movement. Almost 36 (72%) cases had excellent outcome, 11 (22%) cases had good outcome, 3 (6%) cases had poor outcome due to loss of fixation, 47 (94%) patients/parents were satisfied with the final outcome.

Conclusions: Lateral closing wedge osteotomy with a lateral K-wire is a sound, cost-effective, technically less demanding modality of treatment for varus deformity due to malunited supracondylar fracture of humerus in children with minimum complications.


Keywords


Children, Deformity correction, Malunion, Osteotomy, Supracondylar fracture of humerus

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References


Hayer A. Treatment of supracondylar fracture of the humerus by skeletal traction in abduction splint. J Bone Joint Surg Am. 1952;54:623-37.

Piggot J, Graham MK, McCoy GF. Supracondylar fracture of the humerus in children: Treatment by straight lateral contraction. J Bone Joint Surg. 1986;68:577-83.

Henrikson B. Supracondylar fracture of the humerus in children. A late review of end-results with special reference to the cause of deformity, disability and complications. Acta Chir Scand Suppl. 1966;369:1–72.

Wilson PD. Fractures and dislocation in the region of the elbow. Surg Gynaecol Obstet. 1933;56:335-59.

Cramer KE, Green NE, Devito DP. Incidence of anterior interosseous nerve palsy in supracondylar humerus fractures in children. J Pediatr Orthop. 1993;13(4):502-5.

Spinner M, Schreiber SN. Anterior interosseous-nerve paralysis as a complication of supracondylar fracture of the humerus in children. J Bone Joint Surg Am. 1969;51(8):1584-90.

Beaty JH, Kasser JR (eds) Rockwood and Wilkins’ fractures in children, 7th edn. Lippincott Williams and Wilkins, Philadelphia; 2010: 488–532.

Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959;109:145–54.

Tellisi N, Abusetta G, Day M. Management of Gartland’s type III supracondylar fractures of the humerus in children: the role audit and practice guidelines. Injury. 2004;35:1167–71.

Verka PS, Kejriwal U, Singh B. Management of Cubitus Varus Deformity in Children by Closed Dome Osteotomy. J Clin Diagn Res. 2017;11(3):8-12.

Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J Pediatr Orthop. 1998;18(1):38-42.

Hanlon CR, Estes WL. Fractures in childhood: A statistical analysis. Am J Surg. 1954;87:312–23.

Cheng JC, Lam TP, Shen WY. Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma. 1995;9(6):511-5.

Wilkins KE: Residuals of elbow trauma in children. Orthop Clin North Am. 1990;21:291.

Sath S, Shah NA, Peerzada MS. Observations on the correction of cubitus varus post supracondylar fracture of humerus by lateral closed wedge osteotomy and plating in adolescents and adults: A case study of 12 patients. Int J Orthop Sci. 2016;2(1):1-5.

Farr S, Ganger R, Girsch W. Distal humeral flexion osteotomy for the treatment of supracondylar extension-type malunions in children. J Pediatr Orthop. 2017;26(3):195-6.

David L, David G, Weiss JM, Kay RM. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. J Child Orthop. 2011;5:305–12.

Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci. 2001;6:312-5.

Tien YC, Chin HW, Lin GT. Dome corrective osteotomy for cubitus varus deformity. Clin Orthop Rel Res. 2000;380:158-66.

Wong HK, Lee EH, Balasubramaniam P. The lateral condylar prominence. A complication of supracondylar osteotomy for cubitus varus. J Bone Joint Surg Br. 1990;72(5):859–61.

Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am. 2001;83(5):735-40.