Abstract
Introduction:To assess the results of Milch osteotomy in terms of deformity correction and functional outcome in the absence of ulnar nerve transposition.Material and Methods:Nine patients with cubitus valgus deformity greater than 20° with tardy ulnar nerve palsy (TUNP) operated between 2012 and 2017 were evaluated. Correction by Milch osteotomy and fixation was done in each case, without osteosynthesis of the non-union lateral condyle humerus or transposition of the ulnar nerve. At one year post-operatively, carrying angle, elbow function (Mayo Elbow Performance Score) and ulnar nerve symptoms were assessed.Results:The mean carrying angle pre-operatively was 30.8° on the affected side which improved to a mean of 8.3° postoperatively with an average correction of 22.5°. The mean elbow flexion pre-operatively was 129.4° which improved to 133.3° post-operatively. The mean preoperative MEP score was 76.7 which improved to a mean of 92.2 post-operatively (p < 0.01). TUNP recovered completely in all the patients.Conclusion:Milch osteotomy is an effective procedure for cubitus valgus deformity correction and its associated tardy ulnar nerve palsy without a decrease in elbow ROM. Correction of even severe valgus deformities without concurrent anterior transposition of the ulnar nerve is likely to improve ulnar nerve symptoms.
Highlights
To assess the results of Milch osteotomy in terms of deformity correction and functional outcome in the absence of ulnar nerve transposition
Milch osteotomy is an effective procedure for cubitus valgus deformity correction and its associated tardy ulnar nerve palsy without a decrease in elbow range of motion (ROM)
We retrospectively reviewed patients who underwent supracondylar corrective Milch osteotomy between 2012 and 2017 for cubitus valgus deformity and came up with nine patients with tardy ulnar nerve palsy (TUNP) along with cubitus valgus where anterior transposition of the ulnar nerve was not done
Summary
To assess the results of Milch osteotomy in terms of deformity correction and functional outcome in the absence of ulnar nerve transposition. Non-union or malunion of lateral condyle humerus fractures often present with cubitus valgus deformity and tardy ulnar nerve palsy (TUNP) as a late complication. In such cases, the surgeon has osteosynthesis of the non-union and corrective osteotomy with or without ulnar nerve transposition as possible options. Mortazavi et al and Helfet et al have reported that anterior transposition of the ulnar nerve is a common surgical technique in patients presenting late with ulnar nerve symptoms secondary to cubitus valgus deformity[2,3]. It is logical to believe that once the deformity is corrected, the stretch of the nerve should disappear leading to the recovery of neurological symptoms, thereby eliminating the need for transposition
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