Distal Humerus Osteotomy for Supracondylar Fracture Malunion in Children: A Study of Perioperative Complications

Author(s): Weiss JM, Kay RM, Waters P, Yang S, Skaggs DL

Source: Am J Orthop 39(1):22-25, 2010.

Summary:

The authors conducted a retrospective review of 41 patients with varus malunion following supracondylar distal humerus fractures treated with a corrective osteotomy over a fifteen year period (1987-2002). Their objective was to identify the perioperative complications and the associated risk factors. The authors postulated that the historically high rate of potential complications after the osteotomies would be lower in their pediatric tertiary referral center.

Forty-one patients were identified with a mean follow-up period of 9 months. All but one were treated with a lateral closing wedge distal humerus osteotomy. The overall complication rate was 32%. In the first ten year period (1987-1997), the authors noted a higher complication rate of 52%. A lower overall complication rate of 14% (3/22) was observed in the last five years of the study period. The complication rate for lateral entry pin fixation was 13% (2/15) and 38% for all fixation types (medial pins, crossed pins, plate fixation, tension band wiring). There were no differences in complication rate based upon surgical approach. Ulnar nerve palsy as a complication was noted in 10% of the patients (4/41), with no cases noted for the lateral entry pins and 4 cases where all other forms of fixation were utilized.

In conclusion, the authors state that their overall complication at a tertiary referral center was essentially no different than previously reported. However, they do indicate that there was a much lower complication rate in the last five years of the study (1997-2002) where lateral entry pins were utilized and where the surgeons became more adept at this form of fixation for the distal humerus osteotomies.