Distal humeral corrective osteotomy for treatment of supracondylar fracture malunions in children

Purpose:This study aimed to determine the functional and radiographic outcomes following corrective distal humeral osteotomies for the treatment of supracondylar fracture malunions in children. We hypothesized that such secondary reconstructive procedures could restore a reasonable and near-normal amount of functionality in a large patient cohort at a tertiary referral center. Methods:We retrospectively reviewed the clinical and radiological records of 38 children who underwent corrective osteotomy for posttraumatic supracondylar humeral malunion using K-wire fixation. All clinical data were extracted after chart review, including age, sex, dominant side whenever available, follow-up duration, and elbow range of motion preoperatively and at the final visit. Radiographic parameters, including Baumann's angle, humeroulnar angle, humerocondylar angle, and elbow range of motion were evaluated preoperatively, postoperatively, and at the final visit to identify the surgical correction outcomes. Results:The mean age of the patients at fracture was 5.6 (+/- 2.7) years, and the mean age at surgical intervention was 8.6 (+/- 2.6) years. The mean follow-up period of the current series was 28.2 (+/- 31.1) months. Baumann's angle, humeroulnar angle, and humerocondylar angle were successfully restored to physiological ranges (72.6 degrees, 5.4 degrees, and 36.1 degrees, respectively). Postoperatively, elbow extension improved from -22 degrees (+/- 5.7) to -2.7 degrees (+/- 7.2) versus flexion from 115 degrees (+/- 13.2) to 128.2 degrees (+/- 11.1). Three revision surgeries (8%) were encountered. Conclusions:Corrective osteotomy of the distal humerus with K-wire fixation is a reliable method to efficiently correct malunion of the distal humerus in different planes, thereby improving elbow range of motion and appearance.