Date: Thu, 5 Feb 2004 16:45:20 +0100
From: Alo Kullerkann
Subject: abnormal distal humerus s/p pediatric fx
I would like to discuss the next case.
17 y/o female, had supracondylar elbow fracture in childhood which was treated by closed reduction and fixation with K-wires.
Now has elbow ROM 30-90 deg. Complaind moderate pain during activity.
How would you help this young lady?
Looking for your valuable opinion,
Alo Kullerkann, MD.
Mustame Hospital, Tallinn
Date: Thu, 5 Feb 2004 17:04:46 EST
Osteotomy is typically helpful to reduce cosmetic deformity but rarely improves ROM or other objective long term functional parameters. Beware of causing median nerve injury by creating more valgus at the elbow. Removal of the anterior bone MIGHT improve flexion but I doubt it since it has been years (?greater than 10 years) of limited motion and abnormal growth/development of the distal humerus and there are potentially many other causes that will restrict flexion to her current range.
Date: Thu, 5 Feb 2004 19:30:58 -0800
From: Steve Groman
I would not attempt to do anything arthroscopically here. There is much too much distortion of anatomy. I don't believe you will get her a greater arc of motion by any means. Her distal humerus is far too distorted and has developed that way. Her capitellum appears malaligned, pointing more distally than usual which is probably limiting her flexion, andthere is deformity to the ulnohumeral joint. The osteophytes are secondary, and removal may decrease some of her pain at the terminus of extension/flexion, but won't change her motion. Her arc of motion can be changed to allow her EITHER more flexionOR more extension, if an osteotomy is done, for instance- it might be moved to 60-120, or to 0-60 (not particularly functional). An osteotomy to correct the varus deformity will be cosmetic only, and one must be careful of injuring the median nerve.