Lateral Open Wedge Osteotomy and Lateral Condyle Fusion In Situ for Children With Condyle Nonunion and Cubitus Valgus Deformity.

Abstract

Long-term nonunion of the lateral humeral condyle (LHC) can result in progressive cubitus valgus, elbow pain, instability, and delayed ulnar nerve palsy. Various techniques have been proposed for correction, each with its own advantages and disadvantages. The purpose of this study was to introduce a lateral open wedge osteotomy (LOWO) procedure combined with in situ osteosynthesis of nonunited LHC for the treatment of long-term LHC nonunion with cubitus valgus deformity. We evaluated 18 pediatric patients who had a cubitus valgus deformity greater than 10 degrees after nonunion of the LHC for more than 2 years. The LHC was fixed in situ with 1 or 2 cancellous screws, and the LOWO was fixed with a locking plate. All patients underwent clinical and radiologic evaluation, and the pre- and postoperative carrying angle (CA), range of motion (ROM), and Mayo elbow performance score (MEPS) were analyzed. Eighteen patients, with a mean age of 9.9 ± 3.9 years, underwent treatment for LHC nonunion and cubitus valgus deformity after a mean interval of 61.6 ± 24.1 months from the initial injury. The mean follow-up period was 57.6 ± 22.8 months. Union of the LHC and LOWO was achieved in all patients. The mean CA decreased significantly from 31.6 ± 4.8 degrees before surgery to 10.4 ± 2.2 degrees after surgery (P<0.001). Surgery did not decrease elbow range of motion (P=0.202). The mean MEPS increased significantly from a preoperative value of 55 ± 4.9 to a postoperative value of 91.1 ± 5.6 (P<0.001). No significant complications were observed. LOWO combined with in situ fixation of nonunited LHC is an effective approach for treating long-term LHC nonunion associated with cubitus valgus deformity.