Correction of cubitus varus is commonly attempted through supracondylar humeral osteotomy. We hypothesized that lateral distal humeral hemiepiphysiodesis (LDHH) could be used to gradually correct this deformity in children. We conducted a retrospective study including all patients who underwent LDHH with the eight-Plate system between 2008 and 2018, with a minimum 4-year follow-up. We collected demographic, fracture-related, pre- and postoperative clinical (carrying angle (CA), ROM), and radiological data (humeral-ulnar angle (HUA), Baumann angle (BA), shaft-condylar angle (SCA), lateral capitellohumeral angle (LCHA)), as well as data on complications and satisfaction at last follow-up. Fifteen patients were included, with a median follow-up of 81 (64–103) months. All the variables had improved significantly as follows: CA −16 (−18 to −9)°, HUA −16 (−19 to −12)°, BA −11 (−17 to −7)°, SCA 7.5 (3.3 to 13.8)°, LCHA −4.8 (−6.8 to 0.6), flexion 10 (0 to 24)°, and extension 10 (0 to 10)°. The annual correction rate in terms of HUA was 2.41° (1.9 to 3.2). There were 5 cases of aseptic screw loosening, 4 of them requiring replacement, without relation to age at surgery (p = 0.324). Most patients (86.67%) were satisfied, and a relationship was found with younger age at surgery (p = 0.037). In conclusion, preliminary results show that LDHH with the eight-Plate system is an effective technique for mild to moderate cubitus varus deformity correction in children. Patients should be advised of the relatively long duration of implant retention and the possibility of reoperation for screw replacement or implant removal.

Background: Patients with achondroplasia may benefit from limb-lengthening surgery with telescopic intramedullary nails (TIMNs). However, the 5-cm maximum length of the nails used in these patients in their original design may be insufficient. The aim of this research is to analyze the outcomes and complications after reusing the same TIMN for a second consecutive 5-cm lengthening in patients with achondroplasia. Methods: Retrospective study of 26 bones (16 femurs and 10 tibias) in 9 patients with achondroplasia treated for bilateral 2-stage sequential lengthening reusing the same TIMN. On completion of a first stage of 5 cm of elongation, the nail was unlocked, retracted, and re-locked; a second stage of 5 cm of distraction followed. Radiologic and clinical parameters were measured preoperatively and postoperatively, and complications were recorded. Results: The median age of patients at first surgery was 13.54 (12.9 to 16.3) years; 55% were males. The median preoperative height was 121 (117.5 to 127) cm, and the median healing index was 18.12 (14.5 to 32.8) and 26.96 (23.3 to 31.6) d/cm, while time to weight bearing was 185.5 (144.8 to 308.5) and 242.5 (208.5 to 293.8) days for femurs and tibias, respectively. Major complications included 3 cases of moderate ankle equinus, 2 cases of hardware failure (failure to relengthen), 2 premature consolidations, 1 common peroneal neurapraxia, and 2 valgus deformities. Femoral procedures had significantly fewer complications than tibial interventions (7 vs. 15, P=0.03), whereas patients who underwent lengthening of both the femur and tibia did not have significantly higher complication rates (14 vs. 8, P=0.6). Conclusions: This study analyzes lower-limb lengthening in a series of achondroplastic patients using TIMN with the novelty of nail reuse to relengthen the bone. The complication rate found is acceptable, among which, potential damage to the internal lengthening mechanism must be considered, though this complication can usually be easily resolved. Overall, nail reuse seems advisable in cases where bone elongation is indicated, and the size and design of the nail limits the extent of lengthening. Level of Evidence: Level III, retrospective comparative study, before and after intervention.

). Palabras Clave► osteocondromas ► osteocondromatosis múltiple hereditaria ► antebrazo de un solo hueso ► fusión radiocubital ResumenLas deformidades del antebrazo y el acortamiento del cúbito ocurren en un 30 a 70% de los pacientes con osteocondromatosis múltiple hereditaria (OMH), produciendo deformidades angulares y pérdida de la movilidad. Los tratamientos en los pacientes pediátricos con OMH que afecta al antebrazo varían desde la simple observación a la resección de la exostosis asociada o no a osteotomías y/o alargamientos. En los pacientes sintomáticos con deformidades severas, afectación de la articulación radiocubital proximal o distal y pérdida de la prono-supinación, la fusión radiocubital es una alternativa de tratamiento con resultados satisfactorios. Se presenta un paciente con osteocondromatosis múltiple hereditaria y una deformidad severa del antebrazo en la que se realizó una fusión radiocubital distal, obteniéndose unos resultados clínicos y radiológicos excelentes. La reconstrucción en un antebrazo de un solo hueso permite restaurar el eje del antebrazo, mantiene el potencial de crecimiento en el radio distal y proporciona un codo estable mediante una sola cirugía. Keywords► osteochondromas ► multiple hereditary exostoses ► one bone forearm ► radioulnar fusion AbstractForearm deformities and ulnar shortening occurs in 30-70% of patients with multiple hereditary exostoses (MHE) developing angular deformities and lost of movement. Options for treatment of a skeletally immatures child with forearm involvement from osteocondromatosis vary widely from natural history observation through ulnar distraction lengthening in combination radial and ulnar osteotomies. In the symptomatic patient with marked forearm deformity, proximal and distal radioulnar joint impairment and limitation of forearm rotation, a radioulnar fusion is an alternative beneficial procedure. We report a patient with multiple hereditary exostoses and severe deformity of forearm treated with radioulnar fusion, with excellent clinical and radiological results. Single bone forearm restores axial alignment of forearm, maintains forearm growth of distal radius, and provides a stable elbow with restoration of motion in a single-stage procedure.

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