Posttraumatic Cubitus Varus: Respect the Columns.
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
22 Mar 2024
22 Mar 2024
Historique:
medline:
22
3
2024
pubmed:
22
3
2024
entrez:
22
3
2024
Statut:
aheadofprint
Résumé
Posttraumatic cubitus varus is a multiplanar deformity that results from an improperly reduced supracondylar humerus fracture. The prevention of posttraumatic cubitus varus hinges on the stable restoration of all 3 columns of the distal humerus while avoiding malrotation. The collapse of any column leads to varying degrees of deformity in the coronal, sagittal, and/or axial plane. The purpose of this article is to explain the pattern of the deformity and use this to summarize preventative tactics for avoiding its described sequelae. We also summarize, illustrate, and present case examples for the various osteotomies used to correct the deformity, and speculate future directions.
Identifiants
pubmed: 38515131
doi: 10.1097/BPO.0000000000002671
pii: 01241398-990000000-00520
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Wilkins KE. Residuals of elbow trauma in children. Orthop Clin North Am. 1990;21:291–314.
Hyatt BT, Schmitz MR, Rush JK. Complications of pediatric elbow fractures. Orthop Clin. 2016;47:377–385.
Tellisi N, Abusetta G, Day M, et al. Management of Gartland’s type III supracondylar fractures of the humerus in children: the role audit and practice guidelines. Injury. 2004;35:1167–1171.
Holt JB, Glass NA, Bedard NA, et al. Emerging US national trends in the treatment of pediatric supracondylar humeral fractures. JBJS. 2017;99:681–687.
Kim TJ, Sponseller PD. Pediatric supracondylar humerus fractures. J Hand Surg. 2014;39:2308–2311.
O’Driscoll SW, Spinner RJ, McKee MD, et al. Tardy posterolateral rotatory instability of the elbow due to cubitus varus. JBJS. 2001;83:1358–1369.
Heijink A, Vanhees M, van den Ende K, et al. Biomechanical considerations in the pathogenesis of osteoarthritis of the elbow. Knee Surg Sports Traumatol, Arthrosc. 2016;24:2313–2318.
Davids JR, Maguire MF, Mubarak SJ, et al. Lateral condylar fracture of the humerus following posttraumatic cubitus varus. J Pediatr Orthop. 1994;14:466–470.
Abe M, Ishizu T, Shirai H, et al. Tardy ulnar nerve palsy caused by cubitus varus deformity. J Hand Surg. 1995;20:5–9.
Bauer AS, Pham B, Lattanza LL. Surgical correction of cubitus varus. J Hand Surg. 2016;41:447–452.
Jupiter JB, Mehne DK. Fractures of the distal humerus. Orthopedics. 1992;15:825–833.
Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg. 2011;20:440–448.
Marongiu MC, Luppi V, Rovesta C. Sequels of treatment in children’s traumatic lesions. In: Porcellini G, Rotini R, Susanna SK, Di Giacomo S. The Elbow: Principles of Surgical Treatment and Rehabilitation, Springer Cham; 2018: 287–296.
Theruvil B, Kapoor V, Fairhurst J, et al. Progressive cubitus varus due to a bony physeal bar in a 4-year-old girl following a supracondylar fracture: a case report. J Orthop Trauma. 2005;19:669–672.
Gordon JE, Patton CM, Luhmann SJ, et al. Fracture stability after pinning of displaced supracondylar distal humerus fractures in children. J Pediatr Orthop. 2001;21:313–318.
Berdis G, Hooper M, Talwalkar V, et al. Assessment of lateral rotation percentage and rotational deformity of the elbow in type 3 supracondylar humerus fractures: a biomechanical study. J Pediatr Orthop. 2021;41:e605–e609.
Prabhakar P, Pierce W, Standefer K, et al. Can we estimate the amount of malrotation in supracondylar humerus fractures after CRPP? J Orthopaedic Trauma. 2020;34:e245–e249.
Krengel WF III, Wiater BP, Pace JL, et al. Does using the medial or lateral humeral line improve reliability of Baumann angle measurement on plain x-ray? The effect of humeral length visualized on the x-ray. J Pediatr Orthop. 2012;32:373–377.
Silva M, Pandarinath R, Farng E, et al. Inter- and intra-observer reliability of the Baumann angle of the humerus in children with supracondylar humeral fractures. Int Orthop. 2010;34:553–557.
Generoso TO, Pacífico Junior GM, Barcelos FM, et al. The trochlear physeal line angle: a novel method to assess coronal plane alignment of the paediatric distal humerus. J Pediatr Orthop. 2022;31:422–430.
Labelle H, Bunnell WP, Duhaime M, et al. Cubitus varus deformity following supracondylar fractures of the humerus in children. J Pediatr Orthop. 1982;2:539–546.
Pennock AT, Charles M, Moor M, et al. Potential causes of loss of reduction in supracondylar humerus fractures. J Pediatr Orthop. 2014;34:691–697.
De Boeck H, De Smet P, Penders W, et al. Supracondylar elbow fractures with impaction of the medial condyle in children. J Pediatr Orthop. 1995;15:444–448.
Larson L, Firoozbakhsh K, Passarelli R, et al. Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. J Pediatric Orthop. 2006;26:573–578.
Hamdi A, Poitras P, Louati H, et al. Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures. J Pediatr Orthop. 2010;30:135–139.
Kocher MS, Kasser JR, Waters PM, et al. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children: a randomized clinical trial. JBJS. 2007;89:706–712.
Prusick VW, Gibian JT, Ross KE, et al. Surgical technique: closed reduction and percutaneous pinning of posterolaterally displaced supracondylar humerus fractures. J Orthop Trauma. 2021;35:e108–e115.
Rees AB, Schultz JD, Wollenman LC, et al. Internal rotation stress test reduces cross-pinning and improves outcomes in displaced pediatric supracondylar humeral fractures. JBJS Open Access. 2021;6:e21.
Singer G, Kraus T, Ruttenstock EM, et al. Antegrade nailing can prevent cubitus varus and valgus after pediatric supracondylar fractures with impacted columns. J Orthop Trauma. 2013;27:e285–e290.
Lacher M, Schaeffer K, Boehm R, et al. The treatment of supracondylar humeral fractures with elastic stable intramedullary nailing (ESIN) in children. J Pediatr Orthop. 2011;31:33–38.
Acosta AM, Li YJ, Bompadre V, et al. The utility of the early postoperative follow-up and radiographs after operative treatment of supracondylar humerus fractures in children. J Pediatr Orthop. 2020;40:218–222.
Karalius VP, Stanfield J, Ashley P, et al. The utility of routine postoperative radiographs after pinning of pediatric supracondylar humerus fractures. J Pediatr Orthop. 2017;37:e309–e312.
Or O, Weil Y, Simanovsky N, et al. The outcome of early revision of malaligned pediatric supracondylar humerus fractures. Injury. 2015;46:1585–1590.
Beuerlein MJ, Reid JT, Schemitsch EH, et al. Effect of distal humeral varus deformity on strain in the lateral ulnar collateral ligament and ulnohumeral joint stability. J Bone Jt Surg. 2004;86:2235–2242.
Kim HT, Lee JS, Yoo C. Management of cubitus varus and valgus. J Bone Jt Surg. 2005;87:771–780.
Kontogeorgakos VA, Mavrogenis AF, Panagopoulos GN, et al. Cubitus varus complicated by snapping medial triceps and posterolateral rotatory instability. J Shoulder Elbow Surg. 2016;25:e208–e212.
Patiño JM, Corna AR, Michelini A, et al. Elbow posterolateral rotatory instability due to cubitus varus and overuse. Case Rep Orthop. 2018;2018:1–5.
Miyamura S, Oka K, Abe S, et al. Altered bone density and stress distribution patterns in long-standing cubitus varus deformity and their effect during early osteoarthritis of the elbow. Osteoarthr Cartil. 2018;26:72–83.
Amis AA, Dowson D, Wright V. Elbow joint force predictions for some strenuous isometric actions. J Biomech. 1980;13:765–775.
Ippolito E, Moneta MR, d’Arrigo C. Post-traumatic cubitus varus. Long-term follow-up of corrective supracondylar humeral osteotomy in children. J Bone Jt Surg. 1990;72:757–765.
Takahara M, Sasaki I, Kimura T, et al. Second fracture of the distal humerus after varus malunion of a supracondylar fracture in children. J Bone Jt Surg Br Vol. 1998;80:791–797.
Noonan KJ, Jones JW. Recurrent supracondylar humerus fracture following prior malunion. Iowa Orthop J. 2001;21:8.
Mitsunari A, Muneshige H, Ikuta Y, et al. Internal rotation deformity and tardy ulnar nerve palsy after supracondylar humeral fracture. J Shoulder Elbow Surg. 1995;4:23–29.
Fujioka H, Nakabayashi Y, Hirata S, et al. Analysis of tardy ulnar nerve palsy associated with cubitus varus deformity after supra- condylar fracture of the humerus: a report of four cases. J Orthop Trauma. 1995;9:435–440.
Gamble JG, Vorhies JS. Remodeling of sagittal plane malunion after pediatric supracondylar humerus fractures. J Pediatr Orthop. 2020;40:e903–e909.
Shi Q, Yan H, Chen S, et al. Effect of a functional brace in combination with physical therapy for early correction of cubitus varus in young children. BMC Pediatr. 2022;22:1–7.
Soldado F, Diaz-Gallardo P, Cherqaoui A, et al. Unsuccessful mid-term results for distal humeral hemiepiphysiodesis to treat cubitus varus deformity in young children. J Pediatr Orthop. 2022;31:431–433.
Laine JC, Novotny SA, Weber EW, et al. Distal tibial guided growth for anterolateral bowing of the tibia: fracture may be prevented. J Bone Jt Surg. 2020;102:2077–2086.
Bukvić N, Kvesić A, Brekalo Z, et al. The problem of post-traumatic varization of the distal end of the humerus remaining after the recovery of a supracondylar fracture. J Pediatr Orthop B. 2013;22:372–375.
Wilkins KE. Principles of fracture remodeling in children. Injury. 2005;36:SA3–SA11.
Ho CA. Cubitus varus—it’s more than just a crooked Arm!. J Pediatr Orthop. 2017;37:S37–S41.
Devnani AS. Lateral closing wedge supracondylar osteotomy of humerus for post-traumatic cubitus varus in children. Injury. 1997;28:643–647.
Lee SC, Shim JS, Sul EJ, et al. Remodeling after lateral closing-wedge osteotomy in children with cubitus varus. Orthopedics. 2012;35:e823ee828.
Wong HK, Lee EH, Balasubramaniam P. The lateral condylar prominence. A complication of supracondylar osteotomy for cubitus varus. J Bone Joint Surg Br. 1990;72:859–861.
Skaggs DL, Glassman D, Weiss JM, et al. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. J Children’s Orthop. 2011;5:305–312.
Liu Y, Kan L, Sun J, et al. Correction of pediatric cubitus varus by centralization of the distal humeral fragment: a surgical technique to avoid lateral condylar prominence. J Pediatr Orthop. 2023;43:111–116.
Davids JR, Lamoreaux DC, Booker RC, et al. Translation step-cut osteotomy for treatment of post traumatic cubitus varus. J Pediatr Orthop. 2011;31:353e365.
Solfelt DA, Hill BW, Anderson CP, et al. Supracondylar osteotomy for the treatment of cubitus varus in children: a systematic review. Bone Joint J. 2014;96-B:691–700.
Pankaj A, Dua A, Malhotra R, et al. Dome osteotomy for posttraumatic cubitus varus: a surgical technique to avoid lateral condylar prominence. J Pediatr Orthop. 2006;26:61–66.
Kumar K, Sharma VK, Sharma R, et al. Correction of cubitus varus by French or dome osteotomy: a comparative study. J Trauma. 2000;49:717e721.
Belthur MV, Iobst CA, Bor N, et al. Correction of cubitus varus after pediatric supracondylar elbow fracture: alternative method using the Taylor spatial frame. J Pediatr Orthop. 2016;36:608–617.
Marinelli A, Guerra E, Rotini R, et al. Computer-aided planning and 3D-printed surgical guide in patients with extreme cubitus varus deformity: a report of 2 cases. JBJS Case Connect. 2022;12:e22.
Bovid KM, Kohler EJ, Habeck JM, et al. Utilization of a 3D-printed model for preoperative planning and operative osteotomy of a pediatric cubitus varus deformity. JSES Open Access. 2019;3:219–224.
Raney EM, Thielen Z, Gregory S, et al. Complications of supracondylar osteotomies for cubitus varus. J Pediatr Orthop. 2012;32:232–240.
Li J, Wang J, Rai S, et al. 3D-printed model and osteotomy template technique compared with conventional closing-wedge osteotomy in cubitus varus deformity. Sci Rep. 2022;12:6762.
Zhang YW, Xiao X, Gao WC, et al. Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. J Orthop Surg Res. 2019;14:353.
Persiani P, Noia G, de Cristo C, et al. Lateral wedge osteotomy for pediatric post-traumatic cubitus varus: Kirschner-wires or locking angular plate? J Pediatr Orthop B. 2017;26:405–411.
Oppenheim WL, Clader TJ, Smith C, et al. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop Relat Res. 1984;188:34–39.
Hernandez MA III, Roach JW. Corrective osteotomy for cubitus varus deformity. J Pediatr Orthop. 1994;14:487–491.
Liddell TR, Hennrikus WL, Bresnahan JJ. A simple dual-planar osteotomy to correct cubitus varus deformity in children. J Orthopaed Trauma. 2016;30:e340–e345.
Challa S, Agarwal-Harding KJ, Levy P, et al. Supracondylar humerus fractures in low-and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes. Int Orthop. 2020;44:2443–2448.