Purpose
Long-term nonunion of the lateral humerus condyle fracture may lead to progressive
cubitus valgus, elbow pain and instability, and secondary ulnar neuritis. A number
of techniques of osteotomy are available for correction, but each has its disadvantages.
The aim of this study was to present a technique of medial trapezoidal osteotomy for
correcting nonunion of the lateral humeral condyle with an elbow valgus deformity
>20°.
Methods
Eight patients (mean age, 7.5 years) with cubitus valgus, after neglected nonunion
of a lateral humeral condyle fracture of greater than 2 years duration, were treated
with trapezoidal combined osteotomy. The mean interval from the lateral condylar fracture
to surgery was 3.1 years. The osteotomy lines were marked on the bone with a template
made before surgery. The lateral condyle and osteotomy site were fixed with K-wires,
and the elbow joint was immobilized in a plaster brace. Pre- and postoperative carrying
angles, range of motion, elbow function, and ulnar nerve neuropathy were analyzed.
Results
The mean follow-up was 5.9 years. Union of the lateral condyle was achieved in all
patients; 3 healed at 8 weeks, 2 healed at 9 weeks, 2 healed at 10 weeks, and 1 healed
at 12 weeks. The mean carrying angle decreased from 30.1° before surgery to 5.8° after
surgery. The surgery did not reduce the range of motion at the elbow. According to
the Mayo Elbow Performance Score, 6 patients had excellent elbow function, and 2 had
good elbow function at the last follow-up. All preoperative ulnar nerve symptoms resolved.
One patient had a mild surgical site infection. No other complications occurred.
Conclusions
Medial trapezoidal osteotomy appears to be an effective method for treating nonunion
of lateral humeral epicondyle fracture with cubitus valgus deformity.
Type of study/level of evidence
Therapeutic V.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Management of lateral humeral condylar fracture in children.J Am Acad Orthop Surg. 2011; 19: 350-358
- Fractures and dislocations of the elbow region.in: Rockwood Jr., C.A. Wilkins K.E. Beaty J.H. Fractures in Children. 4th ed. JB Lippincott-Raven, 1996: 653-904
- Paediatric lateral condoyle fractures: a systematic review.Arch Orthop Trauma Surg. 2018; 138: 809-817
- Osteosynthesis for nonunion of the lateral humeral condyle.Clin Orthop Relat Res. 2002; 405: 230-241
- Ununited fracture of the LHC of the humerus. A 50-year follow-up.Clin Orthop Relat Res. 1977; 124: 181-183
- Supracondylar osteotomy with Ilizarov fixation for elbow deformities in adults.J Bone Joint Surg Br. 1997; 79: 748-752
- Uniplanar supracondylar humeral osteotomy with preset Kirschner wires for posttraumatic cubitus varus.J Pediatr Orthop. 1994; 14: 471-478
- Fractures of the lateral condyle of the humerus in children.J Bone Joint Surg Am. 1971; 53: 1083-1095
- Observations concerning fractures of the lateral humeral condyle in children.J Bone Joint Surg Br. 1975; 57: 430-436
- An eighty-four year follow-up on a patient with ununited fracture of the lateral condyle of the humerus. A case report.J Bone Joint Surg Am. 1973; 55: 378-380
- Functional evaluation of the elbow.in: Morrey B.F. The Elbow and Its Disorders. Saunders, 2000: 74-83
- Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series.Int Orthop. 2018; 42: 375-384
- Supracondylar dome osteotomy for cubitus valgus deformity associated with a lateral condylar nonunion in children.J Bone Joint Surg Am. 2005; 87: 1456-1463
- Correction of cubitus varus by French or dome osteotomy: a comparative study.J Trauma. 2000; 49: 717-721
- Dome corrective osteotomy for cubitus varus deformity.Clin Orthop Relat Res. 2000; 380: 158-166
- Pentalateral osteotomy for cubitus varus. Clinical experiences of a new technique.J Bone Joint Surg Br. 1989; 71: 667-670
- A new three-dimensional osteotomy for cubitus varus deformity after supracondylar fracture of the humerus in children.J Pediatr Orthop. 1991; 11: 327-331
- Treatment of posttraumatic cubitus varus in the pediatric population with humeral osteotomy and external fixation.J Pediatr Orthop. 1996; 16: 597-601
- Long-standing nonunion of fractures of the lateral humeral condyle.J Bone Joint Surg Am. 2002; 84: 593-598
- Closed reduction of severely displaced radial neck fractures in children.BMC Musculoskelet Disord. 2019; 20: 567
- Trans-olecranon fracture-dislocation of the elbow in children.Int Orthop. 2021; 45: 2025-2031
- Elbow arthroscopy in children and adolescents: analysis of outcome and complications.Eur J Med Res. 2018; 23: 42
- Early diagnosis and treatment of delayed ulnar nerve palsy.Seikei Geka. 1972; 23: 94-102
- Osteosynthesis for old, established non-union of the lateral condyle of the humerus.J Bone Joint Surg Am. 1990; 72: 32-40
- Lateral condylar humerus fractures: which ones should we fix?.J Pediatr Orthop. 2012; 32: S5-S9
- Diagnosis, management and complications of distal humerus lateral condyle fractures in children.Shoulder Elbow. 2018; 10: 114-120
- Dome osteotomy using the paratricipital (triceps-sparing) approach for cubitus varus deformity in children: a surgical technique to avoid lateral condylar prominence.J Pediatr Orthop B. 2016; 25: 62-68
- Modified step-cut osteotomy for post-traumatic cubitus varus: our experience with 14 children.Orthop Traumatol Surg Res. 2011; 97: 741-749
- Reverse V osteotomy of the distal humerus for the correction of cubitus varus.J Bone Joint Surg Br. 2007; 89: 527-531
- The management of cubitus varus and valgus using the Ilizarov method.J Bone Joint Surg Br. 2007; 89: 1615-1619
- Open reduction and internal fixation for the treatment of fractures of the lateral humeral condyle with an early delayed presentation in children: a radiological and clinical prospective study.Bone Joint J. 2016; 98-B: 244-248
- Should we repair nonunion of the lateral humeral condyle in children?.Int Orthop. 2015; 39: 1579-1585
- On osteochondrosis deformas juvenilis capituli humeri including investigation of intra-osseous vasculature in distal humerus.Acta Orthop Scand Suppl. 1959; 38: 1-232
- Microcirculation of the distal humeral epiphyseal cartilage: implications for post-traumatic growth deformities.J Hand Surg Am. 1998; 23: 165-172
- Osteosynthesis for the treatment of non-union of the lateral humeral condyle in children.J Bone Joint Surg Am. 1997; 79: 234-240
- Double dome osteotomy for the treatment of cubitus varus in children.Int Orthop. 2013; 37: 641-646
Article info
Publication history
Published online: January 19, 2023
Accepted:
November 24,
2022
Received:
February 4,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Bo He and Hai Zhao contributed equally to this manuscript.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
