Ito Yurika, Kimura Hiroo, Suzuki Taku, Matsumura Noboru, Iwamoto Takuji, Nakamura Masaya
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
J Orthop Case Rep. 2023 Aug;13(8):117-120. doi: 10.13107/jocr.2023.v13.i08.3840.
Supracondylar humeral fractures (SHFs) in children are mostly extension-type. SHFs have a high risk of cubitus varus deformity, while valgus deformity is rarely described. Nerve palsy can also occur during or after the injury, with most cases recovering spontaneously. Here, we present a rare case of cubitus valgus deformity after a flexion-type SHF with ulnar nerve (UN) palsy, which was successfully treated by corrective osteotomy and anterior transposition of the UN.
A 10-year-old girl had left-sided cubitus valgus deformity with persistent UN palsy 4 months after open reduction and internal fixation (ORIF) at another hospital. Half a year after the initial operation, corrective osteotomy of the distal humerus with neurolysis and subcutaneous anterior transposition of the UN were performed. She showed excellent recovery 14-month postoperatively and reported restored motor and sensory function with symmetrical elbow appearance.
Surgeons usually observe the elbow angle carefully to avoid cubitus varus deformity. However, when treating a case of flexion-type SHFs, ORIF should be conducted to avoid cubitus valgus deformity, which could potentially cause UN traction as well as cosmetic dissatisfaction.
儿童肱骨髁上骨折（SHF）多为伸直型。SHF发生肘内翻畸形的风险较高，而肘外翻畸形则鲜有报道。损伤期间或之后也可能发生神经麻痹，大多数病例可自行恢复。在此，我们报告1例屈曲型SHF合并尺神经（UN）麻痹后出现肘外翻畸形的罕见病例，通过截骨矫形及UN前移术成功治愈。
一名10岁女孩在另一家医院接受切开复位内固定（ORIF）术后4个月，出现左侧肘外翻畸形且UN麻痹持续存在。初次手术后半年，对其进行了肱骨远端截骨矫形、神经松解及UN皮下前移术。术后14个月，她恢复良好，运动和感觉功能恢复，肘部外观对称。
外科医生通常会仔细观察肘角以避免肘内翻畸形。然而，在治疗屈曲型SHF病例时，应进行ORIF以避免肘外翻畸形，因为肘外翻畸形可能导致UN牵拉以及外观不满意。
