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
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.