von Laer L, Brunner R, Lampert C
Traumatologische Abteilung, Kinderspital Basel.
Orthopade. 1991 Nov;20(6):331-40.
We present three important types of posttraumatic deformity of the distal humerus: varus deformity, valgus deformity and complex deformity. Their primary causes are discussed. Slight varus deformities are the result of purely lateral slip of supracondylar fractures or radial overgrowth after a lateral condylar fracture. Severe varus deformities occur after ulnar slip of the distal fragment following supracondylar fracture caused by a rotational deformity. The results after correlation of varus deformities with a rotational deformity are poor. The only way of obviating this problem is to recognize a rotational deformity as soon as possible before adaptation of the elbow occurs, and also to correct it early, if necessary. Valgus deformities occur mostly after radial malunion. Depending on the size of the fragment and the disability of the patient, the fragment should be stabilized-but the potential involvement of the malunion in the elbow function must be borne in mind. Complex deformities and their unknown origins are also discussed. The correction of such deformities depends exclusively on the elbow function. More aggressive primary regimens are urgently needed to prevent the necessity for such secondary corrections, which are very demanding and, depending on the type, have a high failure rate.
内翻畸形、外翻畸形和复杂畸形。讨论了它们的主要成因。轻度内翻畸形是髁上骨折单纯外侧移位或外侧髁骨折后桡骨过度生长的结果。严重内翻畸形发生于髁上骨折后远端骨折块因旋转畸形而向尺侧移位。内翻畸形与旋转畸形相关时预后较差。避免此问题的唯一方法是在肘关节适应前尽快识别旋转畸形，如有必要，尽早进行纠正。外翻畸形大多发生于桡骨畸形愈合后。根据骨折块大小和患者残疾情况，应对骨折块进行固定——但必须牢记畸形愈合对肘关节功能的潜在影响。还讨论了复杂畸形及其不明原因。此类畸形的矫正完全取决于肘关节功能。迫切需要更积极的初始治疗方案，以避免进行此类要求很高且根据类型不同失败率较高的二次矫正。
