Treatment of post-traumatic elbow deformities in children with the Ilizarov distraction osteogenesis technique

Abstract

ObjectiveThe present study assessed functional and radiographic outcomes of distraction osteogenesis treatment of post-traumatic elbow deformities in children.MethodsEight children were treated between 2008 and 2013 for post-traumatic elbow deformities using distraction osteogenesis. Mean age at time of operation was 10.9 years. Six patients had varus and 2 had valgus deformity. Magnitude of correction, fixator index, complications, carrying angle, and elbow range of motion were assessed. Functional results were graded according to protocol of Bellemore et al.ResultsMean follow-up was 43 months. Mean preoperative varus deformity in 6 patients was 29.2° and valgus deformity in 2 patients was 28.5°. Preoperative flexion and extension of elbow were 123.8° and −10.6°, respectively. Mean carrying angle was 9° valgus at last follow-up. Mean flexion and extension were 134.4° and −6.0°, respectively. Change in carrying angle was statistically significant (p = 0.002). There were 2 grade 1 pin tract infections and 1 diaphyseal fracture of humerus. Functional outcome was rated excellent in 7 patients and good in 1 patient.ConclusionIlizarov distraction osteogenesis is a valuable alternative in treatment of elbow deformities in children. The surgical technique is simple and correction is adjustable. Gradual correction prevents possible neurovascular complications and minimally invasive surgery produces less scarring. Compliance of patient and family is key factor in the success of the outcome.Level of evidenceLevel IV, therapeutic study

Post-traumatic cubitus varus: long-term follow-up of corrective osteotomy using the Ilizarov method of compression distraction osteogenesis

“…Lateral prominence has been reported in three out of eleven patients by Piskin et al [24] and one out of eight by Ozkan et al [19]. Our mean postoperative LPI was −1.60 with negative values signifying a medial condylar prominence.…”

“…However, they did not mention how the rotational component was addressed. Karatosun et al [25], Piskin et al [24] and Ozkan et al [19] have also described gradual correction using distraction osteogenesis in their studies on cubitus varus correction, but none of them clearly address the rotational deformity. Besides rotation, the hyperextension deformity, which being in the plane of joint motion, remodels well and hence need not be addressed separately [36].…”

“…One case of valgus over-correction occurred, which was around 5°. Song et al [21] reported one case of overcorrection, while Piskin et al [24], Karatosun et al [25], Bari et al [18] and Ozkan et al [19] reported none. Pintract infection was a common occurrence in studies using external fixation [17][18][19][20][21][22][23][24][25].…”

“…Furthermore, the tendency of the distal fragment to angulate into varus following internal fixation by screws or staples often resulted in a recurrence of the deformity [16]. This led to the emergence of external fixation, ranging from simple monolateral to circular fixators, as an alternative modality of fixation [17][18][19][20][21][22][23][24][25]. Amongst the various devices available, the circular fixator of Ilizarov allows for simultaneous correction of the deformity in three planes [25].…”

“…Unlike single-stage surgical procedures, which achieve acute correction and prohibit further corrections, the method of compression-distraction osteogenesis using external fixation, is the only treatment modality enabling further adjustments to be made postoperatively. However, this method is associated with its own share of complications like over or under-correction, re-fractures, joint stiffness, infections and unsightly scars [17][18][19][20][21][22][23][24][25].…”