Correction of Cubitus Varus After Pediatric Supracondylar Elbow Fracture: Alternative Method Using the Taylor Spatial Frame.

BACKGROUND: Cubitus varus is a well-reported complication of supracondylar fracture of the humerus potentially resulting in cosmetic problems, impaired function, and malpractice claims. Traditional methods of correcting malunited distal humeral fractures involve complex osteotomies that have a high complication rate, require a large exposure, and challenging fixation. We present a technique of gradual correction using a percutaneous transverse osteotomy and 3 dimensional correction with a Taylor Spatial Frame. METHODS: This was a retrospective, IRB-approved study of 12 patients between 2006 and 2010, with cubitus varus after a malunited pediatric supracondylar fracture. The average age at initial injury was 5+8 years. The average age of the patients at surgery was 8+8 years. We measured technical (radiographic parameters and complications), functional (clinical carrying angle, range of motion, QuickDash), and satisfaction domain (questionnaire) outcomes at a minimum follow-up of 6 months. RESULTS: The osteotomy healed in all patients by 10 weeks after the index surgery. The mean external fixator time was 10 weeks. The average preoperative and postoperative humeroulnar angles for the affected elbow were 23 degrees varus and 5.8 degrees valgus, respectively. This was statistically significant (P<0.001). The mean preoperative and postoperative carrying angles were 22 degrees of varus and 5.8 degrees of valgus. This was statistically significant (P<0.001). The results of the QuickDash assessment showed that patients were doing very well with regard to the use of their upper extremity. The mean symptom/disability score was 0.80. No major complications or neurovascular complications were encountered. Overall satisfaction with the procedure was high. CONCLUSIONS: The Taylor Spatial Frame as used in this case series provides the experienced surgeon another safe, accurate, and reliable method to correct cubitus varus after pediatric supracondylar fracture. We used in 7 of our 12 cases, a previously unreported pattern of distal humeral pin fixation that allows for a very distal metaphyseal osteotomy, close to the deformity apex. This is a biplanar delta configuration that straddles the olecranon fossa and is appropriate for both children and adults. LEVEL OF EVIDENCE: Level IV.

Tratamiento de la pseudoartrosis séptica y recalcitrante de la diáfisis humeral mediante impactación intramedular / Treatment of the septic and recalcitrant humeral shaft nounion by means intramedullary impactation

Se presenta un caso de una fractura de la diáfisis humeral complicada con una pseudoartrosis recalcitrante, infección y parálisis radial. Se propone una alternativa de tratamiento que, por su sencillez y aplicabilidad, puede incluirse en el arsenal terapéutico para solucionar esta grave patología (AU)

We present a case of humeral shaft fracture complicated with recalcitrant nonunion, infection and radial nerve paralisys. A treatment alternative sets out that, by its simplicity and applicability, deserves to have it in account within the therapeutic arsenal which we arrange to the solution of this serious pathology (AU)

Fractura de diáfisis humeral en adultos, experiencia con enclavado intramedular con clavo elástico de titanium: Hospital Central de Maracay estado Aragua enero-noviembre 2006 / Fracture of diáfisis humeral in adults, experience with located intramedular with elastic nail of titanium: Hospital Central de Maracay state Aragua january-november 2006

Se valoraron y trataron 7 pacientes adultos con fractura diasfisiaria de húmero, 4 del tipo 12 A2, y un caso con tipos 12 A3, 12 C1, 12 C2, según clasificación AO; se realizó enclavado intramedular elástico de titanio con clavos TENs, fueron valorados según escala de Rockwood y col., modificada por Pérez y Núñez, además de los criterios radiológicos de Balmaceda, observándose 89.71 por ciento de excelencia y 14.28 por ciento bueno, 71 por ciento sexo masculino afectado entre 15-25 años; 42.85 por ciento corresponde a accidentes de tránsito. El tiempo promedio de la técnica quirúrgica 90 minutos, abordaje retrógrado 85.72 por ciento, el promedio de hospitalización 3 días, la movilización de las articulaciones del codo y hombro a las 24 horas postoperatorio, promedio de consolidación de la fractura de 8 semanas, un caso presentó como complicación retardo de consolidación, los arcos de movilidad se consideran buenos a excelentes recuperados para las actividades cotidianas en un promedio de 4 semanas. Podemos concluir que el sistema de enclavado endomedular elástico TENs representa una alternativa de tratamiento para las fracturas diasfisiarias de húmero con trazo simple tipo A2, en pacientes jóvenes, por ser un método cerrado, no amerita inmovilización, y permite realizar rehabilitación precoz de la articulación del codo y hombro inmediata.

Hidatidosis del húmero complicada con fractura, infección bacteriana, fístula y localización extraósea / Humeral hydatidosis complicated with fracture, bacterial infection, fistula and extrabone location

The clinical case of an apparently healthy 63-year-old man from a rural area, with previous contact with dogs, who had a pathological fracture of the right humerus in presented. Initially he presented slight local pain, and functional discapacity. Eigh months later, after a radiological study and surgery (curettage), diagnosis of hydatid disease was made. Later on, after receiving two courses with albendazole, the parient continued in similar conditions for seven years, when his situation became complicated with bacterial, fistula and extraoseous hydatidosis. The humeral was resected and a segmentary prothesis was successfully set