Abstract：
BACKGROUND: Fractures around the elbow are common in children. Their management remains challenging. Inadequate treatment often leads to malunion, causing growth disturbance or avascular necrosis. This can develop into cubital axis deformities. This study evaluated our modified supracondylar dome osteotomy technique for acute correction of posttraumatic cubital axis deformities in adolescent patients.
METHODS: Eighteen cases of posttraumatic cubital axis deformity that underwent acute correction through supracondylar dome osteotomy in our department between 2012 and 2019 were retrospectively evaluated. The radiologic results were measured through the carrying angle. The clinical functional outcomes were assessed using the Mayo Elbow Performance Index.
RESULTS: No neurovascular injuries occurred and there was no notable loss of muscular strength or functional deficiencies in any of the patients. Symmetrical cubital axes were achieved in all cases. All cases were consolidated in a timely matter and no malunion was observed upon consolidation. Besides 1 case of hardware damage caused by a severe fall due to heavy alcohol intoxication, there was no correction loss, no secondary displacement, and no implant-related discomfort. None of the patients were left with a limited range of motion or reduced weight-bearing capacity. An excellent level of elbow functionality was achieved in all cases, with an average Mayo Elbow Performance Index of 97.8.
CONCLUSIONS: The supracondylar dome osteotomy technique showed promising results in both radiologic outcomes and clinical performance, with a low complication rate. The dome-shaped osteotomy allows simultaneous multiplanar correction of not only varus or valgus deformities but also additional extension or flexion deformities. This technique also enables translation of the distal fragment in the frontal plane, which contributes to a more balanced anatomic geometry of the distal humerus. We consider the posterior triceps-splitting approach to be a safe technique that preserves muscle strength and improves the cosmetic appearance of the surgical scar. We recommend a cast-free plate fixation to allow early movement after surgery. We believe any residual deformities that present 18 months after the initial trauma should be addressed through surgical correction before clinical symptoms become apparent to avoid the chronic manifestation of functional deficiencies.
METHODS: Level IV, therapeutic study, case series.
METHODS: Eighteen cases of posttraumatic cubital axis deformity that underwent acute correction through supracondylar dome osteotomy in our department between 2012 and 2019 were retrospectively evaluated. The radiologic results were measured through the carrying angle. The clinical functional outcomes were assessed using the Mayo Elbow Performance Index.
RESULTS: No neurovascular injuries occurred and there was no notable loss of muscular strength or functional deficiencies in any of the patients. Symmetrical cubital axes were achieved in all cases. All cases were consolidated in a timely matter and no malunion was observed upon consolidation. Besides 1 case of hardware damage caused by a severe fall due to heavy alcohol intoxication, there was no correction loss, no secondary displacement, and no implant-related discomfort. None of the patients were left with a limited range of motion or reduced weight-bearing capacity. An excellent level of elbow functionality was achieved in all cases, with an average Mayo Elbow Performance Index of 97.8.
CONCLUSIONS: The supracondylar dome osteotomy technique showed promising results in both radiologic outcomes and clinical performance, with a low complication rate. The dome-shaped osteotomy allows simultaneous multiplanar correction of not only varus or valgus deformities but also additional extension or flexion deformities. This technique also enables translation of the distal fragment in the frontal plane, which contributes to a more balanced anatomic geometry of the distal humerus. We consider the posterior triceps-splitting approach to be a safe technique that preserves muscle strength and improves the cosmetic appearance of the surgical scar. We recommend a cast-free plate fixation to allow early movement after surgery. We believe any residual deformities that present 18 months after the initial trauma should be addressed through surgical correction before clinical symptoms become apparent to avoid the chronic manifestation of functional deficiencies.
METHODS: Level IV, therapeutic study, case series.
摘要：
背景：肘部周围骨折在儿童中很常见。他们的管理仍然具有挑战性。治疗不当往往会导致不愈合,引起生长障碍或血管坏死。这可能发展为肘轴畸形。这项研究评估了我们改良的髁上圆顶截骨术技术，用于急性矫正青少年患者创伤后肘轴畸形。
方法：回顾性分析我科2012年至2019年收治的18例创伤后肘轴畸形患者行髁上截骨急性矫正。通过携带角度测量放射学结果。使用MayoElbow性能指数评估临床功能结果。
结果：所有患者均未出现神经血管损伤，肌肉力量或功能缺陷均未出现。在所有情况下都实现了对称的肘轴。所有病例都及时合并，合并后没有观察到不连。除了1例严重酒精中毒导致严重跌倒造成的硬件损坏外，没有修正损失，无二次位移,也没有植入物引起的不适.没有患者的活动范围有限或负重能力降低。在所有情况下都达到了出色的肘部功能水平，平均梅奥弯头性能指数为97.8。
结论：髁上穹顶截骨技术在放射学结果和临床表现方面均显示出良好的结果，并发症发生率低。圆顶形截骨术不仅可以同时对内翻或外翻畸形进行多平面矫正，还可以对其他伸展或屈曲畸形进行矫正。该技术还可以使远端碎片在额叶平面中平移，这有助于肱骨远端更平衡的解剖几何形状。我们认为后三头肌分裂方法是一种安全的技术，可以保留肌肉力量并改善手术疤痕的外观。我们建议采用无铸钢板固定，以允许手术后的早期运动。我们认为，在初次创伤后18个月出现的任何残留畸形都应在临床症状显现之前通过手术矫正来解决，以避免功能缺陷的慢性表现。
方法：四级，治疗性研究,案例系列。
方法：回顾性分析我科2012年至2019年收治的18例创伤后肘轴畸形患者行髁上截骨急性矫正。通过携带角度测量放射学结果。使用MayoElbow性能指数评估临床功能结果。
结果：所有患者均未出现神经血管损伤，肌肉力量或功能缺陷均未出现。在所有情况下都实现了对称的肘轴。所有病例都及时合并，合并后没有观察到不连。除了1例严重酒精中毒导致严重跌倒造成的硬件损坏外，没有修正损失，无二次位移,也没有植入物引起的不适.没有患者的活动范围有限或负重能力降低。在所有情况下都达到了出色的肘部功能水平，平均梅奥弯头性能指数为97.8。
结论：髁上穹顶截骨技术在放射学结果和临床表现方面均显示出良好的结果，并发症发生率低。圆顶形截骨术不仅可以同时对内翻或外翻畸形进行多平面矫正，还可以对其他伸展或屈曲畸形进行矫正。该技术还可以使远端碎片在额叶平面中平移，这有助于肱骨远端更平衡的解剖几何形状。我们认为后三头肌分裂方法是一种安全的技术，可以保留肌肉力量并改善手术疤痕的外观。我们建议采用无铸钢板固定，以允许手术后的早期运动。我们认为，在初次创伤后18个月出现的任何残留畸形都应在临床症状显现之前通过手术矫正来解决，以避免功能缺陷的慢性表现。
方法：四级，治疗性研究,案例系列。
