Correction of Malunion afterPediatric Supracondylar Elbow Fractures : Closing Wedge Osteotomy andExternal Fixation
Hasler, Carol
In: European Journal of Trauma, 2003, vol. 29, no. 5, p. 309-315
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- Abstract : Background: : Malunion is the most common complication after pediatric supracondylar fractures. Cubitus varus may be cosmetically disturbing, consolidation in hyperextension restricts flexion. There is a considerable rate of complications for corrective osteotomies reported in the literature (incomplete correction, loss of correction, and unsightly scars). Patients and Methods: : 13 patients (six boys and seven girls), average age 11 years (5-23 years), underwent supracondylar closing wedge osteotomies and lateral external fixation. Cubitus varus deformity averaged 23° (15-50°). Four patients were treated by flexion osteotomies, six by valgus osteotomies, and three by combined flexion-valgus osteotomies. Results: : Nine patients showed symmetric carrying angles, three had 5° more valgus on the operated arm. One patient had 10° more varus which still resulted in a physiologic valgus. One patient had slight lateral bony prominence despite symmetric carrying angles. Three patients complaint about unsightly scars. All three had previous open reduction of their fractures with keloids. All patients had already reached a range of motion at the time of metal removal which was within 15° of the values at the time of the latest follow-up. Seven patients with significantly decreased elbow flexion regained an average of 28° of flexion (20-35°). Two superficial pin track infections healed under oral antibiotics. Conclusion: : External fixation facilitates correction by empirically searching for the desired carrying angle, cosmetic appearance, and function of the elbow. Functional aftertreatment shortens the recovery period. Metal removal is easy. Our experience confirms the excellent results in previous series on external fixators