ABSTRACT
@#Tardy ulnar nerve palsy is a known complication of cubitus valgus. The options for treating the ulnar neuropathy include anterior nerve transposition or neurolysis. We report on an 11-year-old boy who had a tardy ulnar nerve palsy due to cubitus valgus resulting from a non-union of a lateral condyle fracture of the humerus. Anterior transposition of the ulnar nerve was not done after the closing wedge osteotomy of the distal humerus. The close wedge osteotomy relieved the tension on the nerve and not transposing the ulnar nerve anteriorly prevented an iatrogenic nerve injury. The patient had no restriction with activities of daily living at the six years follow-up although neurological recovery was incomplete.
ABSTRACT
BACKGROUND: Nonunion of lateral humeral condyle fracture causes cubitus valgus deformity. Although corrective osteotomy or osteosynthesis can be considered, there are controversies regarding its treatment. To evaluate elbow joint biomechanics in non-united lateral humeral condyle fractures, we analyzed the motion of elbow joint and pseudo-joint via in vivo three-dimensional (3D) kinematics, using 3D images obtained by computed tomography (CT) scan. METHODS: Eight non-united lateral humeral condyle fractures with cubitus valgus and 8 normal elbows were evaluated in this study. CT scan was performed at 3 different elbow positions (full flexion, 90° flexion and full extension). With bone surface model, 3D elbow motion was reconstructed. We calculated the axis of rotation in both the normal and non-united joints, as well as the rotational movement of the ulno-humeral joint and pseudo-joint of non-united lateral condyle in 3D space from full extension to full flexion. RESULTS: Ulno-humeral joint moved to the varus on the coronal plane during flexion, 25.45° in the non-united cubitus valgus group and −2.03° in normal group, with statistically significant difference. Moreover, it moved to rotate externally on the axial plane −26.75° in the non-united cubitus valgus group and −3.09° in the normal group, with statistical significance. Movement of the pseudo-joint of fragment of lateral condyle showed irregular pattern. CONCLUSIONS: The non-united cubitus valgus group moved to the varus with external rotation during elbow flexion. The pseudo-joint showed a diverse and irregular motion. In vivo 3D motion analysis for the non-united cubitus valgus could be helpful to evaluate its kinematics.
Subject(s)
Biomechanical Phenomena , Congenital Abnormalities , Elbow , Elbow Joint , Imaging, Three-Dimensional , Joints , Osteotomy , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Cubitus varus and cubitus valgus deformities are common complications of distal humeral fractures in children. We evaluated the usefulness of supracondylar dome osteotomy as a treatment option for adults with cubitus varus or valgus deformity developed during childhood. METHODS: Ten patients who had received supracondylar dome osteotomy and stabilization with plates to treat cubitus varus or valgus deformity between July 2006 and August 2013 were included in this study. Their mean age at the time of surgery was 36.50 ± 10.22 years. The mean follow-up duration was 54.80 ± 32.50 months. We evaluated humerus-elbow-wrist angles (HEWA), improvements in the lateral prominence index (LPI) or medial prominence index (MPI), Mayo elbow performance scores (MEPS), and overall results in accordance with the Banerjee criteria. RESULTS: For the six patients with cubitus varus, the mean postoperative HEWA, mean correction angle, and mean improvement in LPI were 9.72° ± 3.95°, 27.67° ± 10.75°, and 6.92% ± 3.40%, respectively. For the four patients with cubitus valgus, the mean postoperative HEWA, mean correction angle, and mean improvement in MPI were 14.73° ± 2.97°, 11.55° ± 3.26°, and 11.33% ± 6.39%, respectively. There was no significant difference between postoperative and preoperative mean MEPS. The subjective ulnar nerve symptoms were alleviated in all patients. The overall results were excellent in six and good in four patients. CONCLUSIONS: This study suggests that supracondylar dome osteotomy with secure fixation using double plates may be useful in correcting cubitus varus or cubitus valgus deformity, yielding good functional outcomes in adults.
Subject(s)
Adult , Child , Humans , Congenital Abnormalities , Elbow , Follow-Up Studies , Humeral Fractures , Osteotomy , Ulnar NerveABSTRACT
BACKGROUND: Cubitus varus and cubitus valgus deformities are common complications of distal humeral fractures in children. We evaluated the usefulness of supracondylar dome osteotomy as a treatment option for adults with cubitus varus or valgus deformity developed during childhood. METHODS: Ten patients who had received supracondylar dome osteotomy and stabilization with plates to treat cubitus varus or valgus deformity between July 2006 and August 2013 were included in this study. Their mean age at the time of surgery was 36.50 ± 10.22 years. The mean follow-up duration was 54.80 ± 32.50 months. We evaluated humerus-elbow-wrist angles (HEWA), improvements in the lateral prominence index (LPI) or medial prominence index (MPI), Mayo elbow performance scores (MEPS), and overall results in accordance with the Banerjee criteria. RESULTS: For the six patients with cubitus varus, the mean postoperative HEWA, mean correction angle, and mean improvement in LPI were 9.72°± 3.95°, 27.67°± 10.75°, and 6.92% ± 3.40%, respectively. For the four patients with cubitus valgus, the mean postoperative HEWA, mean correction angle, and mean improvement in MPI were 14.73°± 2.97°, 11.55°± 3.26°, and 11.33% ± 6.39%, respectively. There was no significant difference between postoperative and preoperative mean MEPS. The subjective ulnar nerve symptoms were alleviated in all patients. The overall results were excellent in six and good in four patients. CONCLUSIONS: This study suggests that supracondylar dome osteotomy with secure fixation using double plates may be useful in correcting cubitus varus or cubitus valgus deformity, yielding good functional outcomes in adults.
Subject(s)
Adult , Child , Humans , Congenital Abnormalities , Elbow , Follow-Up Studies , Humeral Fractures , Osteotomy , Ulnar NerveABSTRACT
[Objective]To investigate etiopathogenisis,modus operandi and rehabilitation in treatment of bone nonunion and residual deformity (cubitus valgus) after humeral lateral condyle fractures in children. [Method]The author retrospective summarized a total of 27 patients diagnosed with humeral lateral condyle fracture follow with bone nonunion and/or cubitus valgus consecutive enrolled in Children’s Hospital of Chongqing Medical University from 2001 to 2006,including 19 cases of male,8 cases of female,16 cases of right humeral lateral condyle fracture and 11 cases of left. The mean age at injured for all the patients (n =27) was 5.6 yr (range 3-10 yr).The mean age at suigical operation for all the patients (n =27) was 9 yr (range 5-14 yr).The average time from injury to operation was 2.8 yr (range 8mon-10 yr).There were three modus operations including direct normal position internal fixation of 7 cases,open reduction following os illium bone graft internal fixation of 11 cases,distant humerus varus wedge shape cut orthopaedic for 9 cases.[Result]Thirteen patients were followed up ranging from 6 month to 2 years,and 14 patients over 2 years. All the patients were achieved union for 8 to 16 weeks after surgery. Elbow deformity had been corrected and function of elbow joint had been recoverd satisfactorily. All of them,excellent rerult were found in 13 cases,good in 11 cases,and poor in 3 cases,the excellent and good rates was 88.9%. None of the cases happened with osteonecrosis,traumatic arthritis and myositis ossificans.[Conclusion]It is common that delay treatment of humeral lateral condyle fractures in children can result in bone nonunion and residual deformity (cubitus valgus) and it is difficult for treatment. Corresponding surgical treatment with different condition and early exercise can improve the appearance and function of elbow joint.
ABSTRACT
PURPOSE: To analyze the efficiency of simple step-cut translation osteotomy for cubitus varus and valgus deformity of the distal humerus, which was performed using a posterior approach and fixation of a Y-shaped metal plate. MATERIALS AND METHODS: In 20 cases that we were able to observe closely for more than 1year, we classified clinical and radio logical results according to the criteria of Oppenheim and Bellemore. RESULTS: Humerus-Elbow-Wrist angle had been corrected (from 16.6degrees to 7.6degrees in the cubitus varus and from 33.6degrees to 8.3degrees In the cubitus valgus). Change of the lateral and medial prominence index (average 8.38 from -15.74 to -7.36 in the cubitus varus and 7.25 from -17.68 to -10.43 in the cubitus valgus, respectively) provided satisfactory results with decreased protrusion on the medial and lateral condyles. In all cases except one, the range of motion was improved and results were good and excellent. CONCLUSION: Simple step-cut translation osteotomy for the distal humerus obtained very firm fixation with a wedge-shaped osteotomized surface and a Y-shaped metal plate, therefore, early movement was possible. Also because of the dfficiency of the translation osteotomy, we obtained cosmetically satisfactory resullts with a remarkable decreases in protrusion on the medial and lateral condyles.
Subject(s)
Congenital Abnormalities , Humerus , Logic , Osteotomy , Range of Motion, ArticularABSTRACT
The elbow injury is frequent among the children. The cubitus varus and cubitus valgus deformities are the common late complications of the elbow fracture. Although, these deformities rarely limit elbow function, the correction is frequently requested due to cosmetic problem and/or tardy ulnar nerve palsy. We performed 33 supracondylar closed wedge osteotomies from Jan. 1976 to Jan. 1986, of which 27 cases were cubitus varus, and 6 cases were cubitus valgus at Yonsei University College of Medicine. The results were as follows; 1. Cubitus varus deformity was more common than cubitus valgus; the ratio was 4.5 : 1. 2. The most common initial injury resulted in such angular deformity of elbow was supracondylar fracture of humerus. 3. The duration of plaster-cast immobilization after operation was much longer in cases who operated over 15 years old than under 15 years old. 4. There is no relationship between the duration after initial injury and the result of operation. 5. The result of supracondylar osteotomy was excellent in 11 cases(33.3%), good in 17 cases(51.5 %), and poor in 5 cases(15.2%). 6. Three fourths of cases resulted in excellent and good result were under 15 years old. 7. It is recommeneed that the angular deformity of elbow is corrected early rather than at the conclusion of growth.
Subject(s)
Child , Humans , Congenital Abnormalities , Elbow , Humerus , Immobilization , Osteotomy , Ulnar NeuropathiesABSTRACT
Cubitus varus and valgus is one of late complication of elbow fracture, and this deformity is caused usually by malunion in supracondylar fracture or epiphysial injury of the elbow joint. 40 supracondylar closed wedge osteotomies (on cubitus varus 25, cubitus valgus 15) were performed at the supracondylar level and were fixed with two K-wires or French method. The following results were obtained: 1. The frequency of deformity of cubitus varus was higher than that of cubitus valgus: cubitus varus, 25 cases and cubitus valgus, 15 cases. 2. Injury of the supracondylar of the humerus frequentry occured between the age of 6 and 15 (65%). 3. In cubitus varus the degree of deformity ranging from −11° to −30° was the most common whereas in cubitus valgus that ranging from 30° to 40°, 4. Incomplete ulnar nerve palsy was revealed in 15 postoperative cases of cubitus varus of which 3 cases were treated by anterior transposition. In all cubitus valgus, tardy ulnar nerve symptom was disappeared after correction. 5. Nerve damage could be avoid by performing the closed wedge osteotomy and upper connection combind with posterolateral incision in cubitus varus and medial incision in cubitus valgue. 6. Internal fixation associated with cross pinning with two K-wires or French method were performed and good result was obtained without complication even though older case.