Belthur Mohan V, Iobst Christopher A, Bor Noam, Segev Eitan, Eidelman Mark, Standard Shawn C, Herzenberg John E
*Department of Orthopaedic Surgery, Phoenix Children's Hospital, Phoenix, AZ †Department of Orthopaedic Surgery, Miami Children's Hospital, Miami, FL ¶International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD ‡Department of Orthopaedic Surgery, Emek Hospital, Afula ∥Department of Orthopaedic Surgery, Rambam Medical Center, Haifa §Department of Orthopaedic Surgery, Ichilov Hospital, Tel Aviv, Israel.
J Pediatr Orthop. 2016 Sep;36(6):608-17. doi: 10.1097/BPO.0000000000000500.
Cubitus varus is a well-reported complication of supracondylar fracture of the humerus potentially resulting in cosmetic problems, impaired function, and malpractice claims. Traditional methods of correcting malunited distal humeral fractures involve complex osteotomies that have a high complication rate, require a large exposure, and challenging fixation. We present a technique of gradual correction using a percutaneous transverse osteotomy and 3 dimensional correction with a Taylor Spatial Frame.
This was a retrospective, IRB-approved study of 12 patients between 2006 and 2010, with cubitus varus after a malunited pediatric supracondylar fracture. The average age at initial injury was 5+8 years. The average age of the patients at surgery was 8+8 years. We measured technical (radiographic parameters and complications), functional (clinical carrying angle, range of motion, QuickDash), and satisfaction domain (questionnaire) outcomes at a minimum follow-up of 6 months.
The osteotomy healed in all patients by 10 weeks after the index surgery. The mean external fixator time was 10 weeks. The average preoperative and postoperative humeroulnar angles for the affected elbow were 23 degrees varus and 5.8 degrees valgus, respectively. This was statistically significant (P<0.001). The mean preoperative and postoperative carrying angles were 22 degrees of varus and 5.8 degrees of valgus. This was statistically significant (P<0.001). The results of the QuickDash assessment showed that patients were doing very well with regard to the use of their upper extremity. The mean symptom/disability score was 0.80. No major complications or neurovascular complications were encountered. Overall satisfaction with the procedure was high.
The Taylor Spatial Frame as used in this case series provides the experienced surgeon another safe, accurate, and reliable method to correct cubitus varus after pediatric supracondylar fracture. We used in 7 of our 12 cases, a previously unreported pattern of distal humeral pin fixation that allows for a very distal metaphyseal osteotomy, close to the deformity apex. This is a biplanar delta configuration that straddles the olecranon fossa and is appropriate for both children and adults.
Level IV.
肘内翻是肱骨髁上骨折一种报道较多的并发症，可能导致外观问题、功能受损及医疗纠纷索赔。传统纠正肱骨远端骨折畸形愈合的方法包括复杂的截骨术，其并发症发生率高、需要广泛显露且固定具有挑战性。我们介绍一种使用经皮横向截骨术逐步矫正及使用泰勒空间架进行三维矫正的技术。
这是一项经机构审查委员会批准的回顾性研究，研究对象为2006年至2010年间12例小儿髁上骨折畸形愈合后出现肘内翻的患者。初次受伤时的平均年龄为5±8岁。手术时患者的平均年龄为8±8岁。我们在至少6个月的随访中测量了技术（影像学参数和并发症）、功能（临床提携角、活动范围、QuickDash评分）及满意度（问卷调查）方面的结果。
所有患者截骨术后10周均愈合。外固定架平均使用时间为10周。患侧肘关节术前和术后的平均肱尺角分别为内翻23度和外翻5.8度。这具有统计学意义（P<0.001）。术前和术后的平均提携角分别为内翻22度和外翻5.8度。这具有统计学意义（P<0.001）。QuickDash评估结果显示患者上肢使用情况良好。平均症状/残疾评分为0.80。未出现重大并发症或神经血管并发症。患者对该手术的总体满意度较高。
本病例系列中使用的泰勒空间架为经验丰富的外科医生提供了另一种安全、准确且可靠的方法来矫正小儿髁上骨折后的肘内翻。我们在12例病例中的7例使用了一种之前未报道过的肱骨远端钢针固定方式，该方式允许在非常靠近畸形顶点的干骺端进行截骨。这是一种跨越鹰嘴窝的双平面三角形构型，适用于儿童和成人。
四级。
