[Supracondylar osteotomy and lateral column reconstruction for the treatment of lateral humeral condyle fracture nonunion with cubitus valgus]

Askar mamtimin, Adil abdurexit, Akbar yunus
Chinese Journal of Reparative and Reconstructive Surgery 2009, 23 (4): 423-5

OBJECTIVE: To study the surgical procedures and results for treating the nonunion of lateral humeral condyle fracture combined with cubitus valgus in adolescents.

METHODS: From June 2004 to October 2006, 5 patients with nonunion of lateral humeral condyle fracture and cubitus valgus were treated, including 3 males and 2 females aged 8-17 years old. Three cases received external fixation for 2-3 weeks in other hospital, while 2 cases were misdiagnosed as soft tissue injury. The patients were hospitalized after they were diagnosed with nonunion of lateral humeral condyle fracture and cubitus valgus 4-12 years after injury. Preoperatively, the angle of cubitus valgus deformity was 25-55 degrees (average 44.8 degrees), and the elbow motion range of flexion and extension was 135-140 degrees (average 139 degrees) and 0-20 degrees (average 7 degrees), respectively. One case with the symptoms of ulnar neuritis was diagnosed as incomplete injury of ulnar nerve. The time between admission to hospital and operation was 3-7 days. All the patients were treated with wedge shaped supracondylar osteotomy of the distal aspect of humerus and humerus lateral column reconstruction. Regular follow-up was conducted after operation and the elbow function was evaluated according to the scale system of Jupiter et al.

RESULTS: All incisions healed by first intention and all the cases were followed up for 14-28 months (average 20 months). X-ray films revealed that bone union was attained in all the 5 cases, among which the bone union at the supracondylar osteotomy site was reached 5-8 weeks after operation (average 6 weeks) and the bone union at the lateral column reconstruction site was reached 3-6 months after operation. The deformity of cubitus valgus was corrected in all the cases. At latest follow-up, the flexion motion of the elbow was 100-135 degrees (average 121 degrees), and the extension range was 0-30 degrees (average 13 degrees), the angle of postoperative cubitus valgus deformity was - 5-10 degrees (average 2 degrees). According to the system of Jupiter et al, 2 cases were excellent, 2 cases were good and 1 case was fair. One patient and symptoms of radial nerve traction injury after operation and achieved complete recovery 3 months later; and 1 case suffering from ulnar neuritis before operation recovered 6 months after operation. No other complications occurred.

CONCLUSION: It is effective to use wedge-shaped supracondylar osteotomy of the distal aspect of the humerus and lateral column reconstruction through internal fixation to treat the nonunion of the lateral humeral condyle fracture combined with cubitus valgus.

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