The Journal of Bone and Joint Surgery (American). 2006;88:191-201.
doi:10.2106/JBJS.F.00328
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Supracondylar Dome Osteotomy for Cubitus Valgus Deformity Associated with a Lateral Condylar Nonunion in Children

Surgical Technique

Yin-Chun Tien, MD1, Jian-Chih Chen, MD1, Yin-Chih Fu, MD1, Tsai-Tung Chih, PhD2, Peng-Ju Huang, MD1 and Gwo-Jaw Wang, MD1

1 Department of Orthopaedic Surgery, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung City 807, Taiwan, Republic of China. E-mail address for G.-J. Wang: gwojaw{at}cc.kmu.edu.tw
2 Fooyin Institute of Technology, 151 Chinhsueh Road, Ta-Liao Hsiang, Kaohsiung Hsien 831, Taiwan, Republic of China

Investigation performed at the Department of Orthopaedic Surgery, Kaohsiung Medical University, Kaohsiung City, Taiwan, Republic of China

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 87-A, pp. 1456-1463, July 2005

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

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.


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