Supracondylar Subtraction Wedge Osteotomy for the Treatment of Adult Cubitus Valgus
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Published:
Jun 15, 2021
Keywords:
Valgus elbow, osteotomy, sustractive wedge, malunion, supracondylar humeral fracture
Main Article Content
Abstract
Objective: to report the results of a series of adult patients with a valgus malunion of the elbow treated with a supracondylar subtractive monoplanar wedge osteotomy.
Materials and methods: 5 patients were included. The surgical technique consisted of a posterior paratricipital approach, with resection of a subtractive wedge and the anterior transposition of the ulnar nerve. The average follow-up was 17 months.
Results: 4 patients were men and 1 was a woman with an average age of 27 years. The preoperative range of motion was 138°-7° and the postoperative range of motion was 138-6°. Pain according to VAS was 4 and 1, MEPS was 71 and 97, and DASH 6 was 26 and 8, respectively. The preoperative radiological evaluation showed an average valgus of 30º with a contralateral valgus of 11°. The final valgus obtained was 13º. The final correction was, on average, 2° less than the contralateral side. All osteotomies healed and the medial prominence was on average 32% more than before surgery. According to the Oppenheim scale, the results were excellent in 4 patients and good in 1. Personal satisfaction was, on average, 8.6.
Conclusions: Supracondylar subtractive wedge osteotomy is a good option for the treatment of adult cubitus valgus, with a recovery of angular values similar to the contralateral side and a high satisfaction rate. As it is a simpler technique, compared to the multiplanar osteotomies, it is our treatment of choice for adult cubitus valgus.
Materials and methods: 5 patients were included. The surgical technique consisted of a posterior paratricipital approach, with resection of a subtractive wedge and the anterior transposition of the ulnar nerve. The average follow-up was 17 months.
Results: 4 patients were men and 1 was a woman with an average age of 27 years. The preoperative range of motion was 138°-7° and the postoperative range of motion was 138-6°. Pain according to VAS was 4 and 1, MEPS was 71 and 97, and DASH 6 was 26 and 8, respectively. The preoperative radiological evaluation showed an average valgus of 30º with a contralateral valgus of 11°. The final valgus obtained was 13º. The final correction was, on average, 2° less than the contralateral side. All osteotomies healed and the medial prominence was on average 32% more than before surgery. According to the Oppenheim scale, the results were excellent in 4 patients and good in 1. Personal satisfaction was, on average, 8.6.
Conclusions: Supracondylar subtractive wedge osteotomy is a good option for the treatment of adult cubitus valgus, with a recovery of angular values similar to the contralateral side and a high satisfaction rate. As it is a simpler technique, compared to the multiplanar osteotomies, it is our treatment of choice for adult cubitus valgus.
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How to Cite
Gallucci, G., Altube, G., Boretto, J., Donndorff, A., Zaidenberg, E., Rellán, I., & De Carli, P. (2021). Supracondylar Subtraction Wedge Osteotomy for the Treatment of Adult Cubitus Valgus. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(3), 316-323. https://doi.org/10.15417/issn.1852-7434.2021.86.2.1165
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Clinical Research
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References
1. Arnold JA, Nasca RH, Nelson CL. Supracondylar fracture of the humerus: The role of dynamic factors in prevention of deformity. J Bone Joint Surg Am 1977;59:589-95. PMID: 873954
2. Storm SW, Williams DP, Khoury J, Lubahn JD. Elbow deformities after fracture. Hand Clin 2006;22(1):121-9.
https://doi.org/10.1016/j.hcl.2005.12.005
3. Bub FR, Schulz AP, Lill H, Voigt C. Supracondylar osteotomies of posttraumatic distal humeral deformities in
young adults-technique and results. Open Orthop J 2011;5:389-94. ttps://doi.org/10.2174/1874325001105010389
4. Labelle H, Bunnell WP, Duhaime M, Poitras B. Cubitus varus deformity following supracondylar fractures of the
humerus in children. J Pediatr Orthop 1982;2(5):539-46. https://doi.org/10.1097/01241398-198212000-00014
5. Wilkins KE. Fractures and dislocations of the elbow region. En: Rockwood CA, Wilkins KE, King RE (eds.).
Fractures in children, 4th ed. Philadelphia: Lippincott-Raven; 1996:600-887.
6. Amspacher JC, Messenbaugh JF Jr. Supracondylar osteotomy of the humerus for correction of rotational and
angular deformities of the elbow. South Med J 1964; 57:846-50. https://doi.org/10.1097/00007611-196407000-00022
7. Kang HJ, Koh IH, Jeong YC, Yoon TH, Choi YR. Efficacy of combined osteotomy and ulnar nerve transposition for
cubitus valgus with ulnar nerve palsy in adults. Clin Orthop Relat Res 2013;471(10):3244-50.
https:doi.org./10.1007/s11999-013-3057-9
8. Kim HT, Lee JS, Yoo CI. Management of cubitus varus and valgus. J Bone Joint Surg Am 2005;87:771-80.
https://doi.org/10.2106/JBJS.D.01870
9. Wong HK, Lee EH, Balasubramaniam P. The lateral condylar prominence. A complication of supracondylar
osteotomy for cubitus varus. J Bone Joint Surg Br 1990;72:859-61. PMID: 2211772
10. Milch H. Fractures and fracture dislocations of the humeral condyles. J Trauma 1964;4:592-607.
https://doi.org/10.1097/00005373-196409000-00004
11. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH
(Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J
Ind Med 1996;29:602-8. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
12. Morrey BF, An KN, Chao EYS. Functional evaluation of the elbow. En: Morrey BF (ed.). The elbow and its
disorders. 2nd ed. Philadelphia, PA: WB Saunders Co.; 1993:95.
13. Oppenheim WL, Clader TJ, Smith C, Bayer M. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop Relat Res 1984;188:34-9. PMID: 6467726
14. Abed Y, Nour K, Kandil YR, El-Negery A. Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series. Int Orthop 2018;42(2):375-84. https://doi.org/10.1007/s00264-017-3709-6
15. Tachdjian MR. Osteotomy of distal humerus for correction of cubitus varus. En: Smith AB (ed.). Pediatric
orthopedics. Philadelphia: WB Saunders; 1972:1588-91.
16. Roye DP Jr, Bini SA, Infosino A. Late surgical treatment of lateral condylar fractures in children. J Pediatr Orthop 1991;11:195-9. https://doi.org/10.1097/01241398-199103000-00011
17. Fontanetta P, Mackenzie DA, Rosman M. Missed, maluniting, and malunited fractures of the lateral humeral
condyle in children. J Trauma 1978;18:329-35. https://doi.org/10.1097/00005373-197805000-00006
2. Storm SW, Williams DP, Khoury J, Lubahn JD. Elbow deformities after fracture. Hand Clin 2006;22(1):121-9.
https://doi.org/10.1016/j.hcl.2005.12.005
3. Bub FR, Schulz AP, Lill H, Voigt C. Supracondylar osteotomies of posttraumatic distal humeral deformities in
young adults-technique and results. Open Orthop J 2011;5:389-94. ttps://doi.org/10.2174/1874325001105010389
4. Labelle H, Bunnell WP, Duhaime M, Poitras B. Cubitus varus deformity following supracondylar fractures of the
humerus in children. J Pediatr Orthop 1982;2(5):539-46. https://doi.org/10.1097/01241398-198212000-00014
5. Wilkins KE. Fractures and dislocations of the elbow region. En: Rockwood CA, Wilkins KE, King RE (eds.).
Fractures in children, 4th ed. Philadelphia: Lippincott-Raven; 1996:600-887.
6. Amspacher JC, Messenbaugh JF Jr. Supracondylar osteotomy of the humerus for correction of rotational and
angular deformities of the elbow. South Med J 1964; 57:846-50. https://doi.org/10.1097/00007611-196407000-00022
7. Kang HJ, Koh IH, Jeong YC, Yoon TH, Choi YR. Efficacy of combined osteotomy and ulnar nerve transposition for
cubitus valgus with ulnar nerve palsy in adults. Clin Orthop Relat Res 2013;471(10):3244-50.
https:doi.org./10.1007/s11999-013-3057-9
8. Kim HT, Lee JS, Yoo CI. Management of cubitus varus and valgus. J Bone Joint Surg Am 2005;87:771-80.
https://doi.org/10.2106/JBJS.D.01870
9. Wong HK, Lee EH, Balasubramaniam P. The lateral condylar prominence. A complication of supracondylar
osteotomy for cubitus varus. J Bone Joint Surg Br 1990;72:859-61. PMID: 2211772
10. Milch H. Fractures and fracture dislocations of the humeral condyles. J Trauma 1964;4:592-607.
https://doi.org/10.1097/00005373-196409000-00004
11. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH
(Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J
Ind Med 1996;29:602-8. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
12. Morrey BF, An KN, Chao EYS. Functional evaluation of the elbow. En: Morrey BF (ed.). The elbow and its
disorders. 2nd ed. Philadelphia, PA: WB Saunders Co.; 1993:95.
13. Oppenheim WL, Clader TJ, Smith C, Bayer M. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop Relat Res 1984;188:34-9. PMID: 6467726
14. Abed Y, Nour K, Kandil YR, El-Negery A. Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series. Int Orthop 2018;42(2):375-84. https://doi.org/10.1007/s00264-017-3709-6
15. Tachdjian MR. Osteotomy of distal humerus for correction of cubitus varus. En: Smith AB (ed.). Pediatric
orthopedics. Philadelphia: WB Saunders; 1972:1588-91.
16. Roye DP Jr, Bini SA, Infosino A. Late surgical treatment of lateral condylar fractures in children. J Pediatr Orthop 1991;11:195-9. https://doi.org/10.1097/01241398-199103000-00011
17. Fontanetta P, Mackenzie DA, Rosman M. Missed, maluniting, and malunited fractures of the lateral humeral
condyle in children. J Trauma 1978;18:329-35. https://doi.org/10.1097/00005373-197805000-00006