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Research article
Li-wei Xie
Sichuan Provincial Orthopedics Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9147-8346
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: The purpose of this study was to investigate the effect of staged surgery (open reduction/internal fixation and osteotomy) for cubitus valgus after non-union of lateral condylar fractures of the distal humerus in older children.
Methods: From January 2010 to January 2013, 9 patients were treated with two-staged surgery (open reduction/internal fixation and osteotomy). The study included 5 males and 4 females, with a mean age of 12.7 years. The minimum interval from fracture to the first surgery was 7 years and the maximum interval was 10 years (average 8.2 years). All patients had symptoms of injury of the ulnar nerve and instability of the elbow. The first surgery included internal reduction, internal fixation, and bone grafting, exposing the elbow through a Kocher lateral approach. The procedure included clearing the peripheric callus and proximal distal fracture end cicatrix with rongeur until cancellous bone was exposed, and fixation of the lateral condylar fragment with a hollow screw 4.0 mm in diameter and smooth Kirschner wire. The limb was immobilized in a long arm cast with the elbow at 90 degrees of flexion and the forearm in neutral rotation for 3 weeks, and active exercises were begun after removal. The internal fixation hardware was removed after 3 months. The second surgery, osteotomy of the supracondylar humerus, was completed after 6 months to correct cubitus valgus. Internal fixation from the osteotomy was removed 6 months later.
Results: Six months after the second surgery, follow-up revealed that in all patients the lateral condylar fractures attained clinical union and cubitus valgus was corrected. Elbow function recovered well without arthrochalasis or humeral condylar avascular necrosis. All patients’ ulnar nerve injury symptoms disappeared.
Conclusion: Staged surgery to treat cubitus valgus secondary to lateral condylar fracture non-union in older children serves to first provide elbow stability, then to correct cubitus valgus. Staged treatment may make up for the deficiencies of conventional treatment. However, due to our relatively short follow-up time, the long term effects are unknown.
Keywords
children, lateral condylar fracture, treatment, cubitus varus
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CURRENT STATUS: Under Review
The most recent version of this article is available here.
No community comments so far
Editorial decision: Major revision
On 16 Feb, 2021
Review #1 received
Received 07 Feb, 2021
Review #2 received
Received 02 Feb, 2021
Reviewer #2 agreed
On 26 Jan, 2021
Reviewers invited
Invitations sent on 18 Jan, 2021
Reviewer #1 agreed
On 18 Jan, 2021
Editor assigned
On 30 Nov, 2020
Submission checks complete
On 30 Nov, 2020
Editor invited
On 30 Nov, 2020
Version 1
Posted 26 Aug, 2020
No comments provided
Editorial decision: Major revision
On 27 Sep, 2020
Review #2 received
Received 21 Sep, 2020
Review #1 received
Received 21 Sep, 2020
Reviewer #3 agreed
On 08 Sep, 2020
Reviewer #2 agreed
On 06 Sep, 2020
Reviewer #1 agreed
On 27 Aug, 2020
Editor assigned
On 26 Aug, 2020
Reviewers invited
Invitations sent on 26 Aug, 2020
Submission checks complete
On 25 Aug, 2020
Editor invited
On 25 Aug, 2020
First submitted
On 16 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
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A new preprint design is coming!
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This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Li-wei Xie
Sichuan Provincial Orthopedics Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9147-8346
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
The most recent version of this article is available here.
No community comments so far
Editorial decision: Major revision
On 16 Feb, 2021
Review #1 received
Received 07 Feb, 2021
Review #2 received
Received 02 Feb, 2021
Reviewer #2 agreed
On 26 Jan, 2021
Reviewers invited
Invitations sent on 18 Jan, 2021
Reviewer #1 agreed
On 18 Jan, 2021
Editor assigned
On 30 Nov, 2020
Submission checks complete
On 30 Nov, 2020
Editor invited
On 30 Nov, 2020
Version 1
Posted 26 Aug, 2020
No comments provided
Editorial decision: Major revision
On 27 Sep, 2020
Review #2 received
Received 21 Sep, 2020
Review #1 received
Received 21 Sep, 2020
Reviewer #3 agreed
On 08 Sep, 2020
Reviewer #2 agreed
On 06 Sep, 2020
Reviewer #1 agreed
On 27 Aug, 2020
Editor assigned
On 26 Aug, 2020
Reviewers invited
Invitations sent on 26 Aug, 2020
Submission checks complete
On 25 Aug, 2020
Editor invited
On 25 Aug, 2020
First submitted
On 16 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
The most recent version of this article is available here.
Background: The purpose of this study was to investigate the effect of staged surgery (open reduction/internal fixation and osteotomy) for cubitus valgus after non-union of lateral condylar fractures of the distal humerus in older children.
Methods: From January 2010 to January 2013, 9 patients were treated with two-staged surgery (open reduction/internal fixation and osteotomy). The study included 5 males and 4 females, with a mean age of 12.7 years. The minimum interval from fracture to the first surgery was 7 years and the maximum interval was 10 years (average 8.2 years). All patients had symptoms of injury of the ulnar nerve and instability of the elbow. The first surgery included internal reduction, internal fixation, and bone grafting, exposing the elbow through a Kocher lateral approach. The procedure included clearing the peripheric callus and proximal distal fracture end cicatrix with rongeur until cancellous bone was exposed, and fixation of the lateral condylar fragment with a hollow screw 4.0 mm in diameter and smooth Kirschner wire. The limb was immobilized in a long arm cast with the elbow at 90 degrees of flexion and the forearm in neutral rotation for 3 weeks, and active exercises were begun after removal. The internal fixation hardware was removed after 3 months. The second surgery, osteotomy of the supracondylar humerus, was completed after 6 months to correct cubitus valgus. Internal fixation from the osteotomy was removed 6 months later.
Results: Six months after the second surgery, follow-up revealed that in all patients the lateral condylar fractures attained clinical union and cubitus valgus was corrected. Elbow function recovered well without arthrochalasis or humeral condylar avascular necrosis. All patients’ ulnar nerve injury symptoms disappeared.
Conclusion: Staged surgery to treat cubitus valgus secondary to lateral condylar fracture non-union in older children serves to first provide elbow stability, then to correct cubitus valgus. Staged treatment may make up for the deficiencies of conventional treatment. However, due to our relatively short follow-up time, the long term effects are unknown.
Figure 1
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