Kaye E. Wilkins, M.D.

"Fracture trauma about the elbow is one condition that really strikes fear in the hearts of many orthopaedic surgeons because there is such a high incidence of residual deformities. In fact, in some series, residual deformities were reported to be 30-40% . . . fortunately, new understandings and techniques have reduced these residuals."

Inadequate treatment for the pediatric patient continues to be the leading cause of nonunion and/or malalignment of displaced fractures about the elbow. The two primary reasons for inadequate treatment are: 1) the failure to radiographically diagnose a fracture about the elbow present in a child that presents with dislocation; and 2) the failure to take appropriate aggressive surgical management steps for the internal fixation of specific displaced fracture patterns. Two resultant areas of residual elbow trauma are: neurovascular compartment syndromes and the so-called Volkmann's ischemia contracture; and secondly, angular deformities and loss of range of motion.

The focus of this VJO two-part presentation by pediatric orthopaedic specialist Dr. Kaye Wilkins is to identify, offer guidelines as to cause and review those displaced fracture patterns that present the most challenging of diagnostic and therapeutic decisions for the orthopaedic surgeon. Part I will focus on the residuals of supracondylar fractures, including: etiological factors; sequelae of rotational malalignment -- horizontal, sagittal and coronal tilt; and how each of these three planes can influence a residual deformity, such as the common cubitus varus, the occasional cubitus valgus and the loss of extension/flexion. In addition, surgical internal fixation treatment modalities will be evaluated, as well as the dilemma of when to proceed with such procedures and the often encountered trade-off of cosmetic improvement and marginal loss of motion.

References
1. DeRosa GP, Graziano GP A New Osteotomy for Cubitus Varus Clin Orthop 236:160-165, 1988
2. Dhillon KS, Sengupta S, Singh BJ Delayed Management of Fracture of the Lateral Humeral Condyle in Children Acta Orthop Scand 59:419-424, 1988
3. Labelle H, Bunnell WP, Duhaime M, Poitras B Cubitus Varus Deformity Following Supracondylar Fractures of the Humerus in Children J Pediatr Orthop 2:539-546, 1982
4. Oppenheim WL, Clader TJ, Smith C, Bayer M Supracondylar Humeral Osteotomy for Traumatic Childhood Cubitus Varus Deformity Clin Orthop 188:34-39, 1984

• Total Run Time: 21:36 minutes
• Catalog Number: 2502
• Publication Date: June 1990

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