Early correction of malunited supracondylar humerus fractures in young children. Issue 11 (November 2020) - Azzam, Wael
Highlights: The long-standing unsightly cubitus varus deformity causes psychological stress to the child and his/her parents in addition to biomechanical disturbances and functional disorders in the affected elbow. Many authors recommended early correction of paediatric cubitus varus deformity. However, optimal timing of corrective osteotomy is not well-established in the literature. Early correction of cubitus varus avoids the consequences of the long-standing deformity and is associated with marked patient and parents' satisfaction and highly satisfactory cosmetic and functional outcomes. The LCW osteotomy is safe and effective in correcting the deformity. The two lateral and one medial K-wire fixation technique is rigid enough to maintain the correction during osteotomy healing. Removal of the K-wires in the outpatient clinic after osteotomy healing avoids the need for additional surgery for implant removal. Abstract: Introduction: Supracondylar fracture malunion usually results in cubitus varus deformity. The long-standing unsightly deformity causes psychological stress to the child and his/her parents in addition to biomechanical disturbances and functional disorders in the affected elbow. The optimal timing of corrective osteotomy is not well-established in the literature. The present study aimed to report the results of early correction of cubitus varus deformity using a simple technique and to focus on the timing of early correction after supracondylar fracture malunion. Patients and Methods: Thirty consecutive patients treated for recent cubitus varus deformity after malunited supracondylar fractures, in the period between January 2012 and August 2017, were retrospectively reviewed. All patients had early surgical correction of the deformity within one year after the initial injury. In patients who presented with maluniting supracondylar fracture, the fracture was splinted until union was achieved, then active exercises were encouraged until elbow ROM was regained. The deformity was then corrected with a lateral closing wedge (LCW) osteotomy and fixed with two lateral and one medial wire. Results: All the osteotomies united. All the deformities were corrected. The humerus-elbow-wrist (HEW) angle significantly improved compared to the pre-operative values ( p <0.001). All patients achieved satisfactory results at the final evaluation. Twenty-six patients (86.7%) achieved excellent results while four patients (13.3%) achieved good results. Conclusion: Early correction of cubitus varus deformity avoids the psychological stress of the long-standing unsightly deformity to the young child and his/her family. It also avoids the delayed biomechanical and functional disturbances to the affected elbow. The LCW osteotomy and the three-wires fixation technique are simple and effective to correct the deformity and maintain the correction.