[Treatment of posttraumatic cubitus varus in XXXX and adolescents. Supracondylar humeral osteotomy using radial external fixation].

@entity1 @entity174 @entity2270 @entity3579 @entity3192 @entity158 @entity505 @entity893
OBJECTIVE: Precise adaptable fixation of a supracondylar humerus osteotomy with a radial/lateral external fixator to correct posttraumatic cubitus varus. INDICATIONS: Acquired, posttraumatic cubitus varus as a result of a malhealed and unsatisfactorily treated supracondylar humerus @entity174 . @entity3192 (very seldom) if the @entity1 (independent of age and after complete healing) is cosmetically impaired; stability of the elbow is reduced due to @entity893 ( @entity3579 ); secondary problems and @entity158 (e.   g., irritation of the ulnar nerve) are expected or already exist; or there is an explicit wish of the @entity1 /parents (relative indication). CONTRAINDICATIONS: In principle there are no contraindications provided that the indication criteria are filled. The common argument of age does not represent a contraindication in our opinion, since angular remodeling at the distal end of the humerus is practically nonexistent. SURGICAL TECHNIQUE: Basically, the surgical technique of the radial external fixator is used as previously described for stabilization of complex supracondylar @entity174 . With the @entity1 in supine position, the arm is placed freely on an arm table. Using a 4-5 cm long skin incision along the radial, supracondylar, the extracapsular part of the distal humerus is prepared, whereby great caution regarding the radial nerve is advised. In contrast to the procedure used in radial external fixation for supracondylar humeral @entity174 treatment, two Schanz screws are always fixed in each fragment at a distance of 1.5-2 cm. The osteotomy must allow the fragment to freely move in all directions. The proximal and distal two Schanz screws are then connected with short 4 mm @entity505 or stainless steel rods. These two rods are connected with each other over another rod using the tub-to-tub technique. Now the preliminary correction according the clinical situation can be performed and the clamps are tightened. @entity2270 and function are checked. If these are radiologically and clinically perfect, all clamps are definitively tightened; if the alignment or the function is not perfect, then further adjustments can be made. POSTOPERATIVE MANAGEMENT: Due to the excellent stability, further immobilization not necessary. Immediate functional follow-up treatment performed according to @entity158 . RESULTS: Adequate healing is usually expected within 6 weeks. At this time the external fixator can be removed in the @entity174 clinic. Because the whole operation is performed in an extraarticular manner and the mobility of the elbow is not affected, deterioration of function has never been observed. Also regarding the cosmetic/anatomical situation, good results are expected because they were already achieved intraoperatively.
