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Supracondylar Dome Osteotomy for Cubitus Valgus Deformity Associated with a Lateral Condylar Nonunion in Children
Yin-Chun Tien, MD1; Jian-Chih Chen, MD1; Yin-Chih Fu, MD1; Tsai-Tung Chih, PhD2; Peng-Ju Hunag, MD1; Gwo-Jaw Wang, MD1
1 Department of Orthopaedic Surgery, Kaohsiung Medical College, 100, Shih-Chuan 1st Road, Kaohsiung City 807, Taiwan, Republic of China. E-mail address for G.-J. Wang: gwojaw@cc.kmu.edu.tw
2 Fooyin Institute of Technology, 151 Chinhsueh Road, Ta-Liao Hsiang, Kaohsiung Hsien 831, Taiwan, Republic of China
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Investigation performed at the Department of Orthopaedic Surgery, Kaohsiung Medical College, Kaohsiung City, Taiwan, Republic of China

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jul 01;87(7):1456-1463. doi: 10.2106/JBJS.C.01545
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Abstract

Background: Open reduction, autogenous bone-grafting, and internal fixation for the treatment of established nonunion of the lateral condyle associated with a cubitus valgus deformity has a high rate of complications. As a consequence, we developed a new technique that includes in situ compression fixation of the lateral condylar nonunion and a dome-shaped supracondylar osteotomy of the distal aspect of the humerus through a single posterior incision.

Methods: Eight consecutive patients were treated with the new surgical technique between 1994 and 2000. The mean age at the time of surgery was 8.6 years. The mean interval between the lateral condylar fracture and surgery was 4.9 years. The mean preoperative radiographic humerus-ulna angle was 31° of valgus. The postoperative results were classified with a modification of the scoring system described by Dhillon et al., which assesses pain, weakness, range of motion, the humerus-ulna angle, and prominence of the medial epicondyle on a 12-point scale.

Results: All eight lateral condylar nonunions achieved union within three months postoperatively. The mean postoperative humerus-ulna angle was 5.5° of valgus. All of the supracondylar dome osteotomies healed uneventfully, and there was no loss of correction postoperatively. The mean duration of follow-up was 4.5 years. The overall results were excellent in two patients, good in four patients, and fair in two patients.

Conclusions: With better exposure of the lateral condylar nonunion through a posterior approach, we can effectively stabilize the lateral condylar nonunion and avoid postoperative loss of motion and osteonecrosis of the condyle. With a dome-shaped supracondylar osteotomy, we can correct the cubitus valgus deformity and avoid the development of a medial epicondylar prominence. With careful selection of patients, this new technique can be an effective method to treat this clinically challenging problem.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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