WOFAPS 2025 8th World Congress of Pediatric Surgery

Liu Xin

Sichuan province Orthopaedic Hospital,China

Purpose: This retrospective study aimed 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 (5 males, 4 females; mean age, 12.7 years) were treated with two-staged surgery. The average interval from fracture to first surgery was 8.2 years. All patients had symptoms of ulnar nerve injury and elbow instability. The first surgery included open reduction, internal fixation, and bone grafting, exposing the elbow through a lateral approach. The procedure included clearing the peripheric callus, debriding the non-union with rongeur (exposing the cancellous bone), and fixation of the lateral condylar fragment with a cannulated screw and smooth Kirschner wire. The limb was immobilized in a long arm cast for 3 weeks, and active exercises were begun after removal. The second surgery, a medial closing wedge osteotomy of the supracondylar humerus fixated with plate, was completed after 6 months to correct cubitus valgus. Internal fixation was removed 6 months later. Results: Six months after the second surgery, all lateral condylar fractures attained clinical union, and cubitus valgus was corrected. Elbow function recovered well without arthrochalasis or humeral condylar avascular necrosis. All ulnar nerve injury symptoms disappeared. Conclusions: 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.