Posterior Instability of the Shoulder After Supracondylar Fractures Recovered With Cubitus Varus Deformity

Gurkan, Ilksen; Bayrakçı, Kenan; Taşbaş, Bülent A.; Dağlar, Bülent; Günel, Uğur; Uçaner, Ahmet

doi:10.1097/01241398-200203000-00013

Cited by 20 publications

(20 citation statements)

References 19 publications

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“…6,8,15,34,39 Furthermore, several previous studies have shown that residual rotation displacement is associated with tardy ulnar nerve palsy, 1,12,18 nonphysiologic muscle activity around the elbow, 34 and posterior instability of the shoulder. 9 Since French's report on a procedure for lateral closing wedge osteotomy with simultaneous derotation, 8 several surgeons have performed a 3-dimensional (3D) osteotomy to correct the internal rotation, as well as the varus and extension deformities. 6,9,32,39 Criticism of this treatment method has centered on the technical difficulties faced in accurately correcting the 3D deformity and in ensuring rigid fixation with a small contact area at the osteotomy site.…”

mentioning

confidence: 99%

Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus

Takeyasu

Murase

Miyake

et al. 2011

Journal of Shoulder and Elbow Surgery

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confidence: 99%

Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus

Takeyasu

Murase

Miyake

et al. 2011

Journal of Shoulder and Elbow Surgery

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“…An associated or isolated malunion in hyperextension leads to a loss of flexion and may therefore contribute to the disability. Other clinical implications of cubitus varus such as rotatory instability of the elbow, dislocation or snapping of the triceps tendon, tardy ulnar nerve palsy, and posterior instability of the shoulder are less frequent [11][12][13][14].…”

Section: Indication For Surgerymentioning

confidence: 99%

Correction of Malunion after Pediatric Supracondylar Elbow Fractures

Hasler

2003

European Journal of Trauma

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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.

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“…Chronically present, this torque stretches the lateral collateral ligament, leading to posterolateral rotatory instability [6][7][8][9][10]. Additionally, some children may develop posterior shoulder instability with a Bankart lesion [11]. Finally, subluxation of the ulnar nerve and medial head of the triceps over the medial epicondyle can produce pain, snapping, and paresthesias [7,10,12].…”

Section: Introductionmentioning

confidence: 99%

“…Historically, treatment for cubitus varus has been considered for cosmetic reasons only [4]. Recent reports, however, show that these other consequences of cubitus varus may also be indications for operative reconstruction [4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

A new surgical technique for the treatment of supracondylar humerus fracture malunions in children

Skaggs

Glassman

Weiss

et al. 2011

Journal of Children's Orthopaedics

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Purpose To report a new locking lateral closing wedge osteotomy used in repairing pediatric supracondylar humerus fracture malunions, which allows for coronal and sagittal plane correction of both cubitus varus and extension. Methods At our institution, eight children with cubitus varus resulting from prior supracondylar humerus fracture malunions underwent a new technique of lateral closing wedge osteotomy performed by a single surgeon. Preoperative templating created from radiographs of the bilateral upper extremities were compared with clinical exam to determine the angle of triangular bone that must be removed in order to correct the varus and any extension deformity. A lateral approach and subperiosteal dissection exposed the distal humerus. A transverse osteotomy created a proximal and distal fragment, from which two triangles of bone were removed. The fragments were reunited, parallel lateral pins were placed, and live imaging confirmed stable fixation. Results The osteotomy was performed in eight patients, with an average age of 6.3 years. The mean interval between the initial injury and corrective osteotomy was 2.4 years. All patients ended up with flexion of 130°or greater with full and symmetrical pronation and supination. The average ulnohumeral angular correction was 25.5°, which was within 2°of the uninvolved elbow in seven patients and to within 5°in one patient. Baumann's angle averaged 85.3°preoperatively and 73.7°postoperatively, with an average 70.2°in the uninvolved elbow. All of the patients healed with excellent clinical and radiographic alignment and complete function. There were no complications or revisions. Conclusion Varus malunion is a well-described complication of pediatric supracondylar humerus fracture repairs, and many different osteotomy techniques have been described. This series demonstrates that an interlocking lateral wedge osteotomy with parallel lateral pin fixation can provide reliable correction of varus and extension deformity, with a minimal complication rate.

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Posterior Instability of the Shoulder After Supracondylar Fractures Recovered With Cubitus Varus Deformity

Cited by 20 publications

References 19 publications

Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus

Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus

Correction of Malunion after Pediatric Supracondylar Elbow Fractures

A new surgical technique for the treatment of supracondylar humerus fracture malunions in children

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