Trapezoidal Osteotomy for Treatment of Long-Standing Nonunion of Lateral Humeral Condyle Fracture With Cubitus Valgus Deformity

Bo He; Hai Zhao; Guoxin Nan

doi:10.1016/j.jhsa.2022.11.017

Trapezoidal Osteotomy for Treatment of Long-Standing Nonunion of Lateral Humeral Condyle Fracture With Cubitus Valgus Deformity

J Hand Surg Am. 2023 Jan 19:S0363-5023(22)00719-5. doi: 10.1016/j.jhsa.2022.11.017. Online ahead of print.

Authors

Bo He¹, Hai Zhao², Guoxin Nan³

Affiliations

¹ Department of Orthopaedics Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
² Department of Orthopaedics of Chenzhou No.1 People's Hospital, Hu Nan City, China.
³ Department of Orthopaedics Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China. Electronic address: ngx1215@163.com.

PMID: 36681538
DOI: 10.1016/j.jhsa.2022.11.017

Abstract

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.

Keywords: Cubitus valgus deformity; lateral prominence; nonunion lateral humeral condyle; trapezoidal osteotomy.