Post-traumatic cubitus varus. Long-term follow-up of corrective supracondylar humeral osteotomy in children.
Ernesto Ippolito, M R Moneta, Carmelo DʼArrigo
Abstract
Ernesto Ippolito, M R Moneta, Carmelo DʼArrigo
Abstract
The results in twenty-four patients who had had a supracondylar osteotomy of the humerus to correct post-traumatic cubitus varus were reviewed after the patients had completed skeletal growth. The average age of the patients was 7.9 years at operation and thirty-one years at the time of follow-up. The average duration of follow-up was twenty-three years. According to our grading system, seven patients had a good; six, a fair; and eleven, a poor result. All but two of the nineteen patients in whom the humero-ulnar angle had been measured preoperatively lost correction that had been obtained at operation. No correlation was found between the quality of the result and either the age of the patient at operation or the amount of correction that had been obtained at operation. The correction that was obtained at operation was maintained in the two patients in whom the cubitus varus deformity had been caused by malunion of a supracondylar fracture. However, when the deformity followed either physeal injury or supracondylar fracture with damage to the physis secondary to the initial trauma, the correction was not maintained. At the most recent follow-up, three patients were symptomatic, and fourteen were dissatisfied with the cosmetic result because of the residual deformity of the elbow or the postoperative scar, or both. In spite of the partial recurrence of the deformity, which was sometimes severe, all but the three symptomatic patients had a very good functional result. Many of these patients worked at heavy manual labor.
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The results in twenty-four patients who had had a supracondylar osteotomy of the humerus to correct post-traumatic cubitus varus were reviewed after the patients had completed skeletal growth. The average age of the patients was 7.9 years at operation and thirty-one years at the time of follow-up. The average duration of follow-up was twenty-three years. According to our grading system, seven patients had a good; six, a fair; and eleven, a poor result. All but two of the nineteen patients in whom the humero-ulnar angle had been measured preoperatively lost correction that had been obtained at operation. No correlation was found between the quality of the result and either the age of the patient at operation or the amount of correction that had been obtained at operation. The correction that was obtained at operation was maintained in the two patients in whom the cubitus varus deformity had been caused by malunion of a supracondylar fracture. However, when the deformity followed either physeal injury or supracondylar fracture with damage to the physis secondary to the initial trauma, the correction was not maintained. At the most recent follow-up, three patients were symptomatic, and fourteen were dissatisfied with the cosmetic result because of the residual deformity of the elbow or the postoperative scar, or both. In spite of the partial recurrence of the deformity, which was sometimes severe, all but the three symptomatic patients had a very good functional result. Many of these patients worked at heavy manual labor.
Key concepts: Cubitus varus, Medicine, Malunion, Deformity, Surgery, Humerus, Osteotomy, Elbow