Objective To study the surgical procedures and results for treating the nonunion of lateral humeral condyle fracture combined with cubitus valgus in adolescents. Methods From June 2004 to October 2006, 5 patients with nonunion of lateral humeral condyle fracture and cubitus valgus were treated, including 3 males and 2 females aged 8-17 yearsold. Three cases received external fixation for 2-3 weeks in other hospital, while 2 cases were misdiagnosed as soft tissue injury. The patients were hospital ized after they were diagnosed with nonunion of lateral humeral condyle fracture and cubitus valgus 4-12 years after injury. Preoperatively, the angle of cubitus valgus deformity was 25-55° (average 44.8°), and the elbow motion range of flexion and extension was 135-140° (average 139°) and 0-20° (average 7°), respectively. One case with the symptoms of ulnar neuritis was diagnosed as incomplete injury of ulnar nerve. The time between admission to hospital and operation was 3-7 days. All the patients were treated with wedge shaped supracondylar osteotomy of the distal aspect of humerus and humerus lateral column reconstruction. Regular follow-up was conducted after operation and the elbow function was evaluated according to the scale system of Jupiter et al. Results All incisions healed by first intention and all the cases were followed up for 14-28 months (average 20 months). X-ray films revealed that bone union was attained in all the 5 cases, among which the bone union at the supracondylar osteotomy site was reached 5-8 weeks after operation (average 6 weeeks) and the bone union at the lateral column reconstruction site was reached 3-6 months after operation. The deformity of cubitus valgus was corrected in all thecases. At latest follow-up, the flexion motion of the elbow was 100-135° (average 121°), and the extension range was 0-30° (average 13°), the angle of postoperative cubitus valgus deformity was — 5-10° (average 2°). According to the system of Jupiter et al, 2 cases were excellent, 2 cases were good and 1 case was fair. One patient and symptoms of radial nerve traction injury after operation and achieved complete recovery 3 months later; and 1 case suffering from ulnar neuritis before operation recovered 6 months after operation. No other compl ications occurred. Conclusion It is effective to use wedge-shaped supracondylar osteotomy of the distal aspect of the humerus and lateral colum reconstruction through internal fixation to treat the nonunion of the lateral humeral condyle fracture combined with cubitus valgus.
ObjectiveTo investigate the surgical procedures and results of nonunion of lateral humeral condyle fracture combined with cubitus valgus. MethodsBetween January 2006 and September 2011, 19 cases of nonunion of lateral humeral condyle fracture combined with cubitus valgus were treated with supracondylar closing wedge osteotomy, open reduction, autogenous bone grafting, and internal fixation. There were 11 males and 8 females, aged 14-28 years (mean, 21.6 years). The left side was involved in 7 cases, and the right side in 12 cases. The disease duration was 3-22 years (mean, 9 years). The osseous protuberance and enlargement were seen in the lateral condyle of all the cases, with cubitus valgus. Compared with the contralateral side, the angle of cubitus valgus deformity increased (34.00±7.68)° at the affected side. The elbow range of motion of flexion and extension was (117.35±19.77)° in the other 17 patients except 2 patients with joint stiff. Among them, 10 patients had limited mobility. Three patients had ulnar neuritis. ResultsAll the patients obtained primary healing of incision, and no surgery-related complication occurred. Nineteen patients were followed up 2-6 years (mean, 3.2 years). Bony union at lateral condylar fracture site and the supracondylar osteotomy site was achieved in all cases within 6 months postoperatively. In 3 patients with ulnar neuritis, the symptoms of nerve injury disappeared within 6 months. At last follow-up, the angle of cubitus valgus deformity increased (3.21±4.09)° at the affected side when compared with the contralateral side, showing significant difference when compared with preoperative angle (t=30.472, P=0.000). The range of motion of the elbow was 20° and 30° in 2 patients with joint stiff before operation; the elbow range of motion of flexion and extension was (117.64±15.72)° in the other 17 patients, showing no significant difference when compared with preoperative value (t=-0.180, P=0.859). According to the appearance of the elbow, range of motion, and complications, the overall results were classified as excellent in 9 patients, good in 8 patients, and poor in 2 patients; the excellent and good rate was 89.5%. ConclusionSupracondylar closing wedge osteotomy can correct the cubitus valgus deformity and improve the symptoms of ulnar neuritis. Open reduction, autogenous bone grafting, and internal fixation for nonunion of the lateral condyle can effectively stabilize the lateral condylar fracture and promote fracture healing.