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Introduction

Natural History of Malunion in Sagittal Plane in Supracondylar Fracture of the Humerus in Children Hui Wan Park․ Dong Hoon Lee․ Hyun Woo Kim․ Han Kook Yoon․ Bo Ram Kim Yonsei university college of medicine. Introduction. Supracondylar Fx. of humerus Most common Fx. around elbow

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Introduction

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  1. Natural History of Malunion in Sagittal Plane in Supracondylar Fracture of the Humerus in Children Hui Wan Park․ Dong Hoon Lee․Hyun Woo Kim․ Han Kook Yoon․ Bo Ram KimYonsei university college of medicine

  2. Introduction • Supracondylar Fx. of humerus • Most common Fx. around elbow in children • Various complications • Volkmann ischemic contracture • Neurovascular injury • Angular deformity

  3. Introduction Angular deformity • Influencing factor • Initial reduction • Maintenance of reduction • Remodelling potential • Type • Coronal deformity : Cubitus varus, cubitus valgus • Sagittal deformity • Rotational deformity

  4. Introduction Angular deformity • Coronal deformity • low remodelling potential of distal humerus • Langenskiold, Acta Orthop Scand, 1967 • Sagittal deformity • Can expect remodelling of angulation (especially below 7 years) • Lutz von Laer, Pediatric Fracture and Dislocation, 4th ed, 2001 • Remodelling cases of deformity in sagittal plane • Graham HA, Clin Orthop, 1967 • But, no statistical evidence

  5. Introduction Remodelling potential • Affecting Factor • Age • Relation with axis of joint motion • Location of fracture

  6. Purposes • Remodeling power of deformity in sagittal plane according to age • Relationship of deformity in sagittal plane and range of motion • Relationship of deformity in sagittal plane and deformity in coronal plane

  7. Materials • From 1995 to 2003 • Supracondylar Fx. of humerus with anterior angulation • 24 cases • 15male , 9 female • Mean age – 67.7 Mo (16-123Mo) • Mean f/u – 24.2 Mo (12-71Mo)

  8. Materials • Fracture Type (Gartland’s system) • Type I : 5 cases • Type II: 11 cases • Type III: 8 cases # Extension type in all cases

  9. Materials • Treatment • C/R & cast immobilization : 4 cases • C/R & percutaneous pinning : 20 cases

  10. Method • Retrospective analysis • Radiologic evaluation • Clinical evaluation • Radiologic evaluation • Baumann angle • Humerocapitellar angle • Immediate postop, Immediate union(4wks), last f/u

  11. Method Radiologic evaluation Humerocapitellar angle Baumann angle

  12. Method Analysis of results • Wilcoxon signed rank sum test - Remodelling power of humerocapitellar angle • Correlation analysis -Humerocapitellar angle and ROM -Humerocapitellar angle and Baumann angle

  13. Results Remodelling of Humerocapitellar angle

  14. Results Relationship between humerocapitellar angle and elbow flexion

  15. Results Relationship between humerocapitellar angle and elbow extension

  16. Results Correlation coefficient between humerocapitellar angle and Baumann angle

  17. Case • F/7 • Fall from bed

  18. Last F/U (2 Yrs) post op Normal 23’ 50’ 25’

  19. 145’ 130’ Injured side Normal side 25’ 16’

  20. Discussion 1. Remodelling of angulation in sagittal plane was not significant statistically even below 7 years old • Other studies about remodelling of angulation in sagittal plane • Can expect remodelling of angulation (especially below 7 years) Lutz von Laer, Pediatric Fracture and Dislocation, 4th ed, 2001 • Remodelling cases of deformity in sagittal plan Graham HA, Clin Orthop, 1967 • But, no statistical evidence

  21. Discussion 2. Positive relationship between humerocapitellar angle and elbow flexion • No clinical problem with sagittal angulation - Graham HA, Clin Orthop, 1967 • No clinical problem with decrease flexion in this study • Long term f/u needed about clinical outcome

  22. Discussion 3.Positive relationship between humerocapitellar angleand Baumann angle • Supracondylar fracture results in three-plane deformity • Extension type • Varus angulation at coronal plane • Anterior angulation at sagittal plane • Sagittal deformity correlated with coronal deformity in this study

  23. Conclusions • Limited remodelling potential of angulation in sagittal plane even below 7 years old • Humerocapitellar anglehas significant correlation with Baumann angle Careful correction of angulation in sagittal plane is mandatory!

  24. Thank you for your attention

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